2.11 Recruitment Maneuver
Category: UWHC Clinical Policy
Policy Number: August 11, 2015
Section: Respiratory Care Services
A sustained inflation on a mechanically ventilated patient may recruit collapsed alveoli, improve
oxygenation and reduce lung injury. Recruiting the lung and preventing de‐recruitment decreases
the potential for lung injury by avoiding the repetitive shear stress associated with opening and
closing unstable lung units. A successful recruitment maneuver will be evidence by a substantial
improvement in oxygenation (an increase in PaO2 of at least 10 to 20% within 30 minutes of
recruitment) and/or an improved chest radiograph (CXR).
A. All patients will be assessed by the Respiratory Care Practitioner (RCP).
B. Therapy will be provided in accordance with a provider’s order.
C. The provider’s presence throughout the procedure is based on the RCP discretion.
D. The patient must be in an IMC or ICU.
A. Critical care ventilator
B. Hemodynamic monitor
A. Review and acknowledge the provider’s order which should include the following:
1. Level of sustained inflation
a. Adults: Recommended 30 cm H20 as tolerated
b. Pediatrics: Increase PEEP 20 cm H20 above level of existing PEEP to a
maximum PIP of 30 cm H20.
2. Duration of sustained inflation: Recommend 20‐30 seconds for pediatric and
adult or as tolerated.
3. Frequency of sustained inflation
a. Adults: PRN or after disconnects
b. Pediatrics: Every one to two hours as ordered.
4. PEEP level after sustained inflation
a. Adults: See the attached graph for recommended levels
b. Pediatrics: Return to prior ventilator settings, or assess for best
5. Patients may require sedation and/or muscle relaxing medications to tolerate
B. Review the patient’s chart
C. Recruitment maneuver: Refer to related link for specific critical care ventilator.
D. Return to former settings after each recruitment. Wait 30 seconds to one minute and
repeat the recruitment maneuver a total of four times, waiting 30 seconds to one
minute between each maneuver.
E. Return to previous ventilator settings and consider determining best PEEP after
1. Adult: Decrease PEEP to level as defined below:
2. Pediatric: Determine best PEEP/max compliance.
A. Respiratory Care Policy 3.33 PEEP of Maximum Compliance/Saturation.
B. Related Articles:
1. The Acute Respiratory Distress Syndrome Trials Network. Effects of recruitment
maneuvers in patients with acute lung injury and acute respiratory distress
syndrome ventilated with high positive end‐expiratory pressure. Critical Care
Medicine 2003 Vol. 31, No. 11.
2. Prodhan P, Noviski N, Pediatric Acute Hypoxemic Respiratory Failure:
Management of Oxygenation. Journal of Intensive Care Medicine 19(3); 2004
Approved by Director and Medical Director of Respiratory Care.
The original copy of this policy and procedure is available in the Respiratory Care Office – E5/489