There is increasing appreciation that lung-protective strategies are beneficial in patients with acute respiratory distress syndrome. Using low tidal volume in these patients improves survival. However, low tidal volume ventilation may promote alveolar de-recruitment. This has led some to advocate the use of "open lung" strategies that stress the use of high positive end-expiratory pressure levels and recruitment maneuvers. A recruitment maneuver is a sustained increase in airway pressure with the goal to open collapsed lung tissue. A variety of approaches have been used as recruitment maneuvers, including increasing the level of positive end-expiratory pressure, sustained inflation maneuvers, sigh breaths, spontaneous breathing, and others. There have been a number of recent reports describing improvements in arterial oxygenation with the use of recruitment maneuvers. However, the impact of recruitment maneuvers on patient-important outcomes such as survival is unknown.
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