Recruitment maneuvers in three experimental models of acute lung injury: Effect on lung volume and gas exchange

Recruitment maneuvers (RM), consisting of sustained inflations at high airway pressures, have been advocated as an adjunct to mechanical ventilation in acute respiratory distress syndrome (ARDS). We studied the effect of baseline ventilatory strategy and RM on end-expiratory lung volume (EELV) and oxygenation in 18 dogs, using three models of acute lung injury (ALI; n = 6 in each group): saline lavage (LAV), oleic acid injury (OAI), and intratracheal instillation of Escherichia coli (pneumonia; PNM). All three models exhibited similar degrees of lung injury. The PNM model was less responsive to positive end-expiratory pressure (PEEP) than was the LAV or OAI model. Only the LAV model showed an oxygenation response to increasing tidal volume (VT). After RM, there were transient increases in Pa(O₂) and EELV when ventilating with PEEP = 10 cm H₂O. At PEEP = 20 cm H₂O the lungs were probably fully recruited, since the plateau airway pressures were relatively high (≃ 45 cm H₂O) and the oxygenation was similar to pre-injury values, thus making the system unresponsive to RM. Sustained improvement in oxygenation after RM was seen in the LAV model when ventilating with PEEP = 10 cm H₂O and VT = 15 ml/kg. Changes in EELV correlated with changes in Pa(O₂) only in the OAI model with PEEP = 10 cm H₂O. We conclude that responses to PEEP, VT, and RM differ among these models of ALI. RM may have a role in some patients with ARDS who are ventilated with low PEEP and low VT.