Lung recruitment maneuver: is it really safe?

Mechanical ventilation is an important part of the management of severe respiratory failure. Several methods have been introduced to improve oxygenation, including the lung recruitment maneuvers (LRMs). In patients with acute respiratory distress syndrome (ARDS), LRMs may prevent ventilator-induced lung injury (VILI), improve survival and the benefits of implementing this method on ARDS also have been supported by several studies. Lung recruitment maneuvers (LRMs) is a method to recruit collapsed alveoli by temporarily or gradually increasing the transpulmonary pressure. Although LRM is believed to improve oxygenation, some recent studies have consistently shown that it does not produce benefits as expected. Especially in ARDS, LRMs does not show any real benefit, it may even cause unfavorable effects. Until now, it also was not clear how to differentiate LRM responders from non-responders. Based on available evidence, LRM is not recommended as a routine procedure for ARDS patients.