Standardized Use of Recruitment Maneuvers Leads to Higher Mortality in Acute Respiratory Distress Syndrome Patients

To mitigate ventilator-induced lung injury, finding the “right” level of positive end-expiratory pressure (PEEP) for a patient with acute respiratory distress syndrome (ARDS) is important. Identifying optimal PEEP remains challenging: Strategies include titration with pressure–volume curves, using esophageal balloons, (NEJM JW Emerg Med Dec 2008 and N Engl J Med 2008; 359:2095), and empirical trials. No approach has proven to be superior.

Investigators randomized 1010 patients with moderate-to-severe ARDS either to standard PEEP, based on the PEEP protocol from the ARDSnet trial group or to lung recruitment with PEEP set by respiratory-system compliance. The latter approach included administration of neuromuscular blockade followed by a recr…