Recruitment manoeuvres – looking for an evidence base

The PHARLAP open lung approach showed promising short term benefit earlier on in the year in ARDS, but now the evidence for recruitment manoeuvres alone has been meta-analysed by Suzumura. Nearly 1600 patients. No standardized strategy, illness severity or timing. They at least seem safe but outcome gain is less clear. An attempt at isolating the studies with least potential for bias suggests a mortality improvement. An NNT of 17 will encourage enthusiasts but sceptics might pull at the statistics. Evidence strongest in the moderate-severe group. Unclear if previous hints of more help in extra-pulmonary ARDS still stand. Staircase, ramp or 40-at-40, it remains part of the ARDS package, has basic science backing, and doesn’t seem harmful.