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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Nov 4, 2015; 4(4): 278-286
Published online Nov 4, 2015. doi: 10.5492/wjccm.v4.i4.278
Published online Nov 4, 2015. doi: 10.5492/wjccm.v4.i4.278
Recruitment maneuvers in acute respiratory distress syndrome: The safe way is the best way
Raquel S Santos, Pedro L Silva, Patricia RM Rocco, Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
Paolo Pelosi, IRCCS AOU San Martino-IST, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, 16132 Genoa, Italy
Author contributions: Santos RS designed the review, conducted the literature review, wrote the article, and prepared the and table; Silva PL designed the review, conducted the literature review, wrote the article, prepared the figure and table, and supervised all the process; Pelosi P and Rocco PRM wrote the article and supervised all the process.
Supported by Brazilian Council for Scientific and Technological Development (CNPq), Carlos Chagas Filho Rio de Janeiro State Research Foundation (FAPERJ), Department of Science and Technology (DECIT)/Brazilian Ministry of Health; and Coordination for the Improvement of Higher Level Personnel (CAPES).
Conflict-of-interest statement: Authors have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Patricia RM Rocco, MD, PhD, Professor, Laboratory of Pulmonary Investigation, Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Avenida Carlos Chagas Filho, s/n, Bloco G-014, Ilha do Fundão, Rio de Janeiro 21941-902, Brazil. prmrocco@gmail.com
Telephone: +55-21-39386530 Fax: +55-21-22808193
Received: May 30, 2015
Peer-review started: May 30, 2015
First decision: August 14, 2015
Revised: September 8, 2015
Accepted: October 20, 2015
Article in press: October 27, 2015
Published online: November 4, 2015
Peer-review started: May 30, 2015
First decision: August 14, 2015
Revised: September 8, 2015
Accepted: October 20, 2015
Article in press: October 27, 2015
Published online: November 4, 2015
Core Tip
Core tip: Experimental and clinical studies show that stepwise recruitment maneuvers (RMs) improve oxygenation and lung aeration and are associated with less hemodynamic instability and inflammatory impact on lung tissue compared to traditional abrupt maneuvers. Patients with severe acute respiratory distress syndrome, characterized by increased edema and atelectasis, are good candidates for RMs. Patients whose oxygenation improves with increased pressure are at lower risk of death. Post-recruitment positive end-expiratory pressure (PEEP) titration is critical to maintaining stabilization of alveolar units and avoiding derecruitment. The use of individualized PEEP based on lung compliance might move clinical management forward.