Recruitment maneuvers in patients with acute respiratory distress syndrome: a systematic review and metanalysis

Abstract

OBJECTIVE: To systematically review the effects of recruitment maneuvers on patients with acute respiratory distress syndrome. METHODS: This systematic review and meta-analysis using the PICO methodology with keywords (respiratory distress syndrome, recruitment maneuvers, lung recruitment, acute respiratory distress syndrome, alveolar recruitment, and adult acute respiratory distress syndrome). Studies involving patients >18 years, regardless of sex, with acute respiratory distress syndrome, mechanically ventilated for at least 24 h, published in English, Portuguese, and Spanish, with no year restrictions, were included. Studies that combined recruitment maneuvers with other techniques and those conducted in animals were excluded. Boolean operators "AND" and "OR" were used. RESULTS: Fifteen studies were included. The recruitment maneuver proved to be effective in oxygenating patients (mean difference=45.05 mmHg (95% confidence interval (95%CI): 31.37-58.74)), but there was no statistically significant difference in the rate of mortality OR=0.89 (95%CI=0.74-1.08) and barotrauma RR=0.93 (95%CI=0.56-1.54). CONCLUSION: Recruitment maneuvers should not be used routinely in the care of patients with acute respiratory distress syndrome, but it is a good rescue strategy when other methods fail to improve oxygenation. PROSPERO DATABASE REGISTRATION: (www.crd.york.ac.uk/prospero) under ID CRD42021227231.