Lung Recruitment Maneuvers for ARDS Patients: A Systematic Review and Meta-Analysis

Abstract

<b><i>Background:</i></b> Lung recruitment maneuvers (LRMs) may reduce mortality and improve oxygenation in patients with acute respiratory distress syndrome (ARDS). However, the existing literature provides controversial conclusions. <b><i>Objectives:</i></b> To determine whether LRMs have benefits on ARDS patients. <b><i>Searching Methods:</i></b> We searched relevant studies in PubMed, EMBASE, Medline, and the Cochrane Library up to May 2018. We considered for inclusion all prospective and randomized controlled trials which compared LRMs and non-LRM in adult patients with ARDS. We collected data about in-hospital mortality, 28-day mortality, the length of ICU and hospital stay, PaO<sub>2</sub>/FiO<sub>2</sub>, and FiO<sub>2</sub>. <b><i>Main Results:</i></b> Ten trials including 3,025 patients were analyzed. No significant difference was found in the hospital and 28-day mortality, as well as the length of ICU stay and oxygen requirement, even undergoing subgroup analysis. However, the results of this meta-analysis showed a significant benefit of LRMs for shortening the length of hospital stay (mean difference, MD = –1.75; 95% CI, –3.40 to –0.09; <i>p</i> = 0.04; <i>p</i> for heterogeneity = 0.3, <i>I</i><sup>2</sup> = 18%) and improving PaO<sub>2</sub>/FiO<sub>2</sub> ratio on the third day (MD = 52.72; 95% CI, 18.77–86.67; <i>p</i> = 0.002), but with extremely high heterogeneity (<i>p</i> for heterogeneity <0.0001, <i>I</i><sup>2</sup> = 99%). <b><i>Conclusion:</i></b> LRMs do not produce significant reduction of mortality in patients with ARDS but may shorten the length of hospital stay and improve oxygenation on the third day. However, the results must be interpreted cautiously as most studies were on multiple intervention exposures.

Intubation and Ventilation amid the COVID-19 Outbreak

“…Lung recruitment maneuvers do not significantly reduce mortality but may improve oxygenation and shorten the length of hospital stay in ARDS patients. 42 Overall, recruitment maneuvers are not supported by high-quality evidence, 43 and caution should be exercised when using it because it can be irritating, incite coughing, and generate aerosols.…”

Acute respiratory distress syndrome: a life threatening associated complication of SARS-CoV-2 infection inducing COVID-19

“…Nevertheless, some new clinical trials sound promising such as the use of higher positive end-expiratory pressure (Dries, 2019 ). It has also been shown that lung recruitment maneuvers may improve the oxygenation process and shorten the hospital stay period in ARDS (Cui et al., 2020 ) and avoid the pro-inflammatory processes triggered by mechanical ventilation (Spadaro et al., 2019 ) . Because in ARDS, the lung injury is accompanied with an acute onset, the recognition and the determination of the respiratory damage threshold would certainly be a key point for a better and efficient ARDS therapy (Dries, 2019 ).…”

Efficacy and safety of different mechanical ventilation strategies for patients with acute respiratory distress syndrome: Systematic review and network meta-analysis

“…that the total amount of lung recruitment tissue increased with ARDS severity [33]. A recent two pairwise meta-analysis suggested that RM had no advantageous effect on mortality [13,34]. Higher PEEP reduced mortality in the subgroup for patients with ARDS who responded to increased PEEP by improved oxygenation; overall, higher PEEP was not an advantageous for patients with ARDS [11].…”