Recruitment maneuver does not provide any mortality benefit over lung protective strategy ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis and systematic review of the randomized controlled trials

Sulagna Bhattacharjee; Kapil D Soni; Souvik Maitra

doi:10.1186/s40560-018-0305-9

Recruitment maneuver does not provide any mortality benefit over lung protective strategy ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis and systematic review of the randomized controlled trials

J Intensive Care. 2018 Jun 26:6:35. doi: 10.1186/s40560-018-0305-9. eCollection 2018.

Authors

Sulagna Bhattacharjee¹, Kapil D Soni², Souvik Maitra¹

Affiliations

¹ 1Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Room No. 5011, 5th Floor Teaching block, Ansari Nagar New Delhi, 110029 India.
² 2Department of Trauma Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute Medical Sciences, New Delhi, India.

Abstract

Background: Clinical benefits of recruitment maneuver in ARDS patients are controversial. A number of previous studies showed possible benefits; a large recent study reported that recruitment maneuver and PEEP titration may even be harmful. This meta-analysis was designed to compare the clinical utility of recruitment maneuver with low tidal volume ventilation in adult patients with ARDS.

Methods: Randomized controlled trials comparing recruitment maneuver and lung protective ventilation strategy with lung protective strategy ventilation protocol alone in adult patients with ARDS has been included in this meta-analysis. PubMed and Cochrane Central Register of Controlled Trials were searched from inception to 10 November 2017 to identify potentially eligible trials. Pooled risk ratio (RR) and standardized mean difference (SMD) were calculated for binary and continuous variables respectively.

Results: Data of 2480 patients from 7 randomized controlled trials have been included in this meta-analysis and systemic review. Reported mortality at the longest available follow-up [RR (95% CI) 0.93 (0.80, 1.08); p = 0.33], ICU mortality [RR (95% CI) 0.91 (0.76, 1.10); p = 0.33] and in-hospital mortality [RR (95% CI) 0.95 (0.83, 1.08); p = 0.45] were similar between recruitment maneuver group and standard lung protective ventilation group. Duration of hospital stay [SMD (95% CI) 0.00 (- 0.09, 0.10); p = 0.92] and duration of ICU stays [SMD (95% CI) 0.05 (- 0.09, 0.19); p = 0.49] were also similar between recruitment maneuver group and standard lung protective ventilation group. Risk of barotrauma was also similar.

Conclusion: Use of recruitment maneuver along with co-interventions such as PEEP titration does not provide any benefit in terms of mortality, length of ICU, and hospital stay in ARDS patients.

Keywords: ARDS; Open lung; PEEP titration; Recruitment maneuver.