• Eddy Fan, William Checkley, Thomas E Stewart, John Muscedere, Olivier Lesur, John T Granton, Andreas P Freitag, Michael Jacka, Niall D Ferguson, and Maureen O Meade.
• Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. efan@mtsinai.on.ca
• Resp Care. 2012 Nov 1;57(11):1842-9.

BackgroundThere are limited data on the safety and efficacy of recruitment maneuvers (RMs) in acute lung injury (ALI) patients.ObjectiveTo evaluate the frequency, timing, and risk factors for complications from RMs in adult ALI patients.MethodsSecondary analysis of data from a randomized controlled trial of a lung open ventilation strategy that included sustained inflation RMs.ResultsRespiratory (eg, desaturation) and cardiovascular (eg, hypotension) complications from recruitment maneuvers were common (22% of all patients receiving RMs), and the majority occurred within 7 days of enrollment. New air leak through an existing chest tube was uncommon (< 5%). As compared to patients receiving 1 or fewer RMs, the number of RMs received was associated with increased risk in both younger (age ≤ 56 y) and older patients (age > 56 y): 2 RMs odds ratio [OR] 6.92 (95% CI 1.70-28.2), ≥ 3 RMs OR 15.4 (95% CI 4.77-49.6), and 2 RMs OR 5.43 (95% CI 1.76-16.8), ≥ 3 RMs OR 4.93 (95% CI 1.78-13.7), respectively. Patients with extrapulmonary ALI had decreased odds of developing complications (OR 0.42, 95% CI 0.22-0.80).ConclusionsComplications in adult ALI patients receiving RMs were common, but serious complications (eg, new air leak through an existing chest tube) were infrequent. There is a significant association between the number of RMs received and complications, even after controlling for illness severity and duration. Given their uncertain benefit in ALI patients, and the potential for complications with repeated application, the routine use of sustained inflation RMs is not justified.

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