Recruitment manoeuvres as a ventilation strategy for adults with acute respiratory failure due to lung injury

This wcochrane-57-1as published in the Cochrane Database of Systematic Reviews in November 2016.  The plain language summary is shown below with links to the full text of the review available via this link.

Background:  Acute respiratory failure is a common condition amongst adults admitted to intensive care units (ICUs) worldwide. Although respiratory failure has many causes, it may be due to a condition known as acute respiratory distress syndrome (ARDS). This term describes a condition in which both of the lungs have become injured and inflamed from one of various causes, and they do not work as they normally would to provide oxygen to and remove carbon dioxide from the body. This leads to a reduced amount of oxygen in the blood. Patients may require connection to a ventilator (breathing machine) to support their breathing. This therapy is known as mechanical ventilation. Supportive care with mechanical ventilation is an important pillar of standard treatment for patients with ARDS.

Although it may be life-saving, mechanical ventilation may further contribute to lung injury by expanding and collapsing the lungs or overstretching lung tissue. To minimize damage to injured lungs, smaller volumes of air at lower pressures have been used in conjunction with a positive opening pressure at the end of expiration (PEEP). This ventilation strategy has been shown to shorten the time that patients require mechanical ventilation while improving survival; it has been adopted as standard care for patients with ARDS who are in intensive care.

Along with this strategy, additional ventilation techniques have been developed. One such technique is known as a recruitment manoeuvre; when combined with higher PEEP, it is called the open lung ventilation strategy. A recruitment manoeuvre uses sustained deep breaths to assist in the recruitment – or re-opening – of collapsed lung units. This may increase the number of lung units available for breathing and may improve patient outcomes. Effects of recruitment manoeuvres have not been well established.

Search date: Evidence is current to August 2016.

Study characteristics: We included 10 trials in this review, which included a total of 1658 participants with acute respiratory distress syndrome.

Key results: Low-quality evidence suggests that recruitment manoeuvres improve ICU survival but not 28-day or hospital survival. Recruitment manoeuvres have no effect on the risk of air leakage from the lungs.

Quality of the evidence: We found the evidence for most outcomes to be of low to moderate quality, primarily because of the design of included trials. Many trials used the recruitment manoeuvre in conjunction with other ventilation techniques or strategies, and this might have influenced outcomes. Caution should be applied when conclusions are drawn about the effectiveness of the recruitment manoeuvre alone.

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