Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation: a systematic review and meta-analysis

PURPOSE: To determine if recruitment manoeuvres (RMs) would decrease 28-day mortality of patients with acute respiratory distress syndrome (ARDS) compared with standard care. MATERIALS AND METHODS: Relevant randomized controlled trials (RCTs) published prior to April 26, 2018 were systematically searched. The primary outcome was mortality. The secondary outcomes were oxygenation, barotrauma or pneumothorax, the need for rescue therapies. Data were pooled using the random effects model. And the quality of evidence was assessed by the GRADE system. RESULTS: Of 3180 identified studies, 15 were eligibly included in our analysis (N = 2755 participants). In the primary outcome, RMs were not associated with reducing 28-day mortality (RR 0.90; 95% CI 0.74–1.09), ICU mortality (RR 0.92; 95% CI 0.74–1.1), and the in-hospital mortaliy (RR 1.02; 95% CI 0.93–1.12). In the secondary outcomes, RMs could improve oxygenation (MD 37.85; 95% CI 11.08–64.61), the rates of barotrauma (RR 1.42; 95% CI 0.83–2.42) and the need for rescue therapies (RR 0.69; 95% CI 0.42–1.12) did not show any difference in the ARDS patients with RMs. CONCLUSIONS: Earlier meta-analyses found decreased mortality with RMs, in the contrary, our results indicate that RMs could improve oxygenation without detrimental effects, but it does not appear to reduce mortality.