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Critical Care

Open Access

Maximal recruitment strategy minimizes tidal recruitment in severe ARDS: a CT scan study

  • G Matos1,
  • J Borges2,
  • V Okamoto2,
  • C Carvalho2,
  • M Amato2 and
  • C Barbas1
Critical Care201014(Suppl 1):P186

Published: 1 March 2010


High PeepTitration PhasePeep TitrationTidal RecruitmentNonaerated Lung


The maximal recruitment strategy (MRS) is considered an efficient maneuver to reverse nonaerated lung in ARDS patients. There is no information regarding tidal recruitment during MRS.


Early and severe ARDS patients were submitted to MRS guided by thoracic CT: A - recruitment phase (PEEP 10 to 45 cmH2O and constant driving pressure 15 cmH2O); B - PEEP titration phase (PEEP 25 to 10 cmH2O). Images were obtained at end expiration and inspiration. Global and regional quantitative CT analyses from each step of PEEP were compared [1].


Analyses of 12 patients showed that MRS reduced significantly the global amount of nonaerated tissue (54 ± 8% to 7 ± 6%, P < 0.01), tidal recruitment (4 ± 4% to 1 ± 1%, P = 0.029) (Figure 1). Most dependent regional tidal recruitment significantly increased from PEEP 10 to 20 cmH2O (2 ± 3% to 11 ± 7%, P < 0.01), but significantly decreased after MRS (11 ± 7% to 2 ± 2%, P < 0.01). High PEEP (25 cmH2O) was necessary to sustain recruitment.
Figure 1

Percentage of regional (I to IV) tidal recruitment during all steps of the MRS protocol.


MRS decreased nonaerated areas and tidal recruitment. Increasing PEEP without full recruitment may cause lung injury exacerbation in the severe ARDS population.

Authors’ Affiliations

Hospital Albert Einstein, São Paulo, Brazil
Universidade de São Paulo, São Paulo, Brazil


  1. Borges JB, et al.: Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome. Am J Respir Crit Care Med 2006, 174: 268-278. 10.1164/rccm.200506-976OCPubMedView ArticleGoogle Scholar


© BioMed Central Ltd. 2010