Respiratory controversies in the critical care setting. Should recruitment maneuvers be used in the management of ALI and ARDS?

Lung recruitment maneuvers are being used in the management of acute lung injury and acute respiratory distress syndrome, but recruitment maneuvers are controversial. The proponents argue that when properly applied to appropriately selected patients, they are effective and can be safely applied. The expectation is that the recruitment maneuver will change the course of ARDS and improve outcomes. Those opposed to recruitment maneuvers argue that no data indicate better outcomes with recruitment maneuvers and that they are potentially unsafe. Outcome data are clearly needed before recruitment maneuvers can be fully incorporated into clinical practice. If a recruitment maneuver is conducted, a decremental positive end-expiratory pressure (PEEP) trial must be done to determine the minimum PEEP that sustains the benefits of the recruitment maneuver. We explore both sides of the lung recruitment controversy.