What are recruitment maneuvers and what are their risks?

• A. Temporary increases in airway pressures to reopen alveoli; risk of barotrauma and hemodynamic instability.
• B. Prolonged low-pressure recruitment to avoid barotrauma.
• C. Only used in COPD.
• D. Always safe with no risks.

Answer: (A)

Recruitment maneuvers involve transiently raising airway pressures to reopen collapsed or flooded alveoli and improve ventilation in mechanically ventilated patients, especially when oxygenation is poor due to alveolar collapse. The purpose is to recruit more lung units so that the ventilated lung becomes more compliant and gas exchange improves.

The best choice describes this idea accurately: these maneuvers temporarily increase airway pressures to reopen alveoli, but they carry real risks. The main risks are barotrauma, such as pneumothorax or pneumomediastinum, from overdistension of fragile lung tissue, and hemodynamic instability because the sudden rise in intrathoracic pressure can reduce venous return to the heart and lower cardiac output. Because of these potential harms, recruitment maneuvers must be used selectively, with careful monitoring, and are typically followed by setting appropriate PEEP to maintain the recruited alveoli.

Why the other statements aren’t correct: recruitment maneuvers aren’t simply prolonged, low-pressure efforts intended to avoid barotrauma; that wouldn’t achieve the goal of reopening collapsed units. They’re not limited to COPD and are more commonly discussed in ARDS or other conditions with alveolar collapse. And they’re not without risk; they require careful indication, technique, and monitoring.