UMEM Educational Pearls

Title: Recruitment Maneuvers

Posted: 3/4/2014 by Mike Winters, MD
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Recruitment Maneuvers for ARDS

Patients with ARDS who are ventilated with lung protective settings are at risk of derecruitment/collapse of lung units.
Recruitment maneuvers are processes that transiently increase transpulmonary pressure to open collapsed units.
These maneuvers can improve oxygenation and have been used in patients with ARDS and those with refractory hypoxemia.
The various types of recruitment methods include:
- Airway pressure-based maneuver: a continuous positive airway pressure of 35-45 cm H₂O is applied for 30-40 seconds
- Ventilator modes: Airway pressure release ventilation (APRV) and high-frequency oscillatory ventilation (HFOV)
- Prone positioning
Adverse events can occur with recruitment maneuvers and include hypotension, hypoxia, and pneumothorax (rare).

Keenan JC, et al. Lung recruitment in acute respiratory distress syndrome: what is the best strategy? Curr Opin Crit Care 2014; 20:63-8.