Pearls of recruitment maneuver

1. Usually used 'rule of thumb' of  recruitment maneuver is "40-40" - application of a high level of continuous positive airway pressure of 40 cm H2O for 40 seconds, though most of the alveolar recruitment occurs during the first ten seconds of the maneuver
2. Hypotension associated with recruitment maneuver is usually benign and recovers within 30 seconds - so don't panic.
3. Recruitment maneuver gives best results if followed by high levels of PEEP (usually equal to more than 14-16 cm H2O)
4. Recruitment maneuvers may essentially needed after a patient has been disconnected from the ventilator. Even few seconds without PEEP may cause alveolar collapse.

References:

 1. Fan E, Wilcox ME, Brower RG, et al. Recruitment maneuvers for acute lung injury: a systematic review. Am J Respir Crit Care Med 2008; 178:1156.

 2. Arnal JM, Paquet J, Wysocki M, et al. Optimal duration of a sustained inflation recruitment maneuver in ARDS patients. Intensive Care Med 2011; 37:1588. 

 3. Foti G, Cereda M, Sparacino ME, et al. Effects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients. Intensive Care Med 2000; 26:501. 

4.Maggiore SM, Lellouche F, Pigeot J, et al. Prevention of endotracheal suctioning-induced alveolar derecruitment in acute lung injury. Am J Respir Crit Care Med 2003; 167:1215.