• Monique Engel, Relana M E Nowacki, Lucy K Reiss, Stefan Uhlig, Coen H M P Willems, Nico Kloosterboer, J Freek van Iwaarden, Alide C P Sewing, Matthias Seehase, Verena A C Lambermont, Jennifer J P Collins, Luc J I Zimmermann, Gijs D Vos, and Boris W Kramer.
• Department of Paediatrics, School for Oncology and Developmental Biology-GROW, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. M.Engel@mumc.nl
• Lung. 2013 Feb 1; 191 (1): 77-86.

BackgroundRecruitment manoeuvres are widely used in clinical practice to open the lung and prevent lung injury by derecruitment, although the evidence is still discussed. In this study two different recruitment manoeuvres were compared to no recruitment manoeuvres (control) in ventilated sheep with acute respiratory distress syndrome (ARDS), induced by lung lavage.MethodsWe performed a prospective, randomised study in 26 ventilated sheep with ARDS, to evaluate the effect of two different recruitment manoeuvres on gas exchange, blood pressure and lung injury. The two different recruitment manoeuvres, the high pressure recruitment manoeuvre (HPRM), with high peak pressure, and the smooth and moderate recruitment manoeuvre (SMRM), with lower peak pressure, were compared to controls (no recruitment) after disconnection. Oxygenation index and ventilation efficacy index were calculated to evaluate gas exchange. Lung injury was assessed by inflammatory response in broncho-alveolar lavage fluid (BALF) and blood and histology of the lung.ResultsOxygenation index improved significantly after both recruitment manoeuvres compared with controls, but no significant difference was found between the recruitment manoeuvres. Blood pressure decreased after HPRM but not after SMRM. HPRM induced a higher number of total cells and more neutrophils in the BALF. In the histology of the lung, mean alveolar size was increased in the dorsocranial region of the lung of SMRM compared to controls.ConclusionRecruitment manoeuvres improved oxygenation, but SMRM was superior, with respect to hemodynamics and pulmonary inflammation, in ventilated sheep suffering from ARDS induced by lung lavage.

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