Recruitment manoeuvres for adults with acute lung injury receiving mechanical ventilation.

Hodgson, Carol; Keating, Jennifer L; Holland, Anne E; Davies, Andrew R; Smirneos, Lorena; Bradley, Scott J; Tuxen, David

BACKGROUND Recruitment manoeuvres are often used to treat patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) but the effect of this treatment on clinical outcomes has not been well established. OBJECTIVES The objective of this review was to examine recruitment manoeuvres compared to standard care as therapy for adults with acute lung injury in order to quantify the effects on patient outcomes (mortality, length of ventilation, and other relevant outcomes). SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 2); MEDLINE (January 1966 to May 2008); EMBASE (January 1980 to May 2008); LILACS (1982 to May 2008); CINAHL (1982 to May 2008); and Current Controlled Trials (www.controlled-trials.com). SELECTION CRITERIA We included randomized controlled trials of adults who were mechanically ventilated comparing recruitment manoeuvres to standard care for those patients diagnosed with ALI or ARDS. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS Seven trials met the inclusion criteria for this review (the total number of included participants was 1170). All trials included a recruitment manoeuvre as part of the treatment strategy for patients on mechanical ventilation for ARDS or ALI. However, two of the trials included a package of ventilation that was different from the control ventilation in aspects other than the recruitment manoeuvre. The intervention group showed no significant difference on 28-day mortality (RR 0.73, 95% CI 0.46 to 1.17, P = 0.2). Similarly there was no statistical difference for risk of barotrauma (RR 0.50, 95% CI 0.07 to 3.52, P = 0.5) or blood pressure (MD 0.9 mm Hg, 95% CI -4.28 to 6.08, P = 0.73). Recruitment manoeuvres significantly increased oxygenation above baseline levels for a short period of time in four of the five studies that measured oxygenation. There were insufficient data on length of ventilation or hospital stay to pool results. AUTHORS' CONCLUSIONS There is not evidence to make conclusions on whether recruitment manoeuvres reduce mortality or length of ventilation in patients with ALI or ARDS.