Lung recruitment maneuvers during acute respiratory distress syndrome: is it useful?

Although significant advances have been made in approaches to manage the acute respiratory distress syndrome (ARDS), reported overall mortality for ARDS is still high. Recruitment maneuvers (RM) have been recommended by some as potential adjuncts to lung protective ventilatory approaches in ARDS. In this point of view issues surrounding the use of RM in ARDS are addressed. Specifically, the ability of RM to open the lung, the safety of RM, and their affect on outcome are addressed. Finally, a specific approach to performing RM with the use of a decremental PEEP trial is outlined.