Recruitment maneuvers and high PEEP during mechanical ventilation in ARDS

What is the role of recruitment maneuvers and high positive end-expiratory pressure (PEEP; “open lung strategy”) during mechanical ventilation in patients with acute respiratory distress syndrome?

Maureen Meade: We have a number of large randomized clinical trials assessing PEEP. None of these studies in and of themselves showed a really clear benefit to that approach, but when we put them all together in an individual patient data meta-analysis that brought together international investigators and all of their randomized clinical trial data, it is suggested that for patients who are very hypoxic with severe ARDS there is probably a role for open lung ventilation strategies and higher PEEP levels, if you will.

The role for lung recruitment maneuvers is a little less clear. They have been included in a number of randomized clinical trials as part of a package for opening the lung and keeping the lung open in ARDS, but there have been few randomized clinical trials that just isolate the lung recruitment maneuver to see to what extent it contributes to improved survival for these patients. I am not clear on this and I do not think that anyone can really be too dogmatic about the benefits or harms of recruitment maneuvers in ARDS. I do know that they are frequently utilized.