Efficacy and safety of lung recruitment maneuvers in acute respiratory distress syndrome: a systematic review and meta-analysis

Nataly Rosario Pacheco Serrano; Jorge Gabriel Maldonado Cornejo; Diana Jazmina Maldonado Borja; Samuel Olegario Iñiguez Jimenez

doi:10.1590/SciELOPreprints.16715

##article.authors##

Nataly Rosario Pacheco Serrano Central University of Ecuador https://orcid.org/0000-0001-8966-3094
- Conceptualization
- Investigation
- Software
- Writing – Original Draft Preparation
Jorge Gabriel Maldonado Cornejo Central University of Ecuador https://orcid.org/0000-0002-0508-7286
- Data Curation
- Methodology
- Supervision
- Writing – Review & Editing
Diana Jazmina Maldonado Borja Central University of Ecuador https://orcid.org/0000-0002-5104-3989
- Formal Analysis
- Project Administration
- Visualization
Samuel Olegario Iñiguez Jimenez Pontifical Catholic University of Ecuador https://orcid.org/0000-0002-4722-7611
- Funding Acquisition
- Resources
- Validation

DOI:

https://doi.org/10.1590/SciELOPreprints.16715

Keywords:

Acute respiratory distress syndrome, Lung recruitment maneuvers, Mechanical ventilation, Positive end-expiratory pressure, Meta-analysis

Abstract

The physiological rationale behind recruitment maneuvers centers on the mechanical reopening of atelectatic lung units in adult ARDS; nonetheless, current clinical data fails to establish a consistent therapeutic benefit. This PRISMA 2020 systematic review and meta-analysis, registered in PROSPERO (CRD420261419966), examined randomized studies of recruitment maneuvers during invasive mechanical ventilation. Data collection involved an electronic screening of English-language studies published between January 1, 2012, and February 28, 2026, utilizing the MEDLINE/PubMed, Embase, CENTRAL, Scopus, Science Citation Index Expanded, LILACS, and Google Scholar databases. This primary strategy was formally paired with cross-reference tracking and clinical trial registry auditing to maximize study retrieval. Recruitment strategies differed markedly, ranging from open-lung and stepwise protocols to PEEP-titrated recruitment, prone-position combined recruitment, sigh maneuvers and sustained inflation. Five studies were pooled for mortality, with no significant reduction in risk compared with control ventilation strategies (RR 1.07; 95% CI 0.96–1.19; I² = 0.0%). Barotrauma or pneumothorax also showed no significant pooled difference, although heterogeneity was substantial (RR 0.95; 95% CI 0.30–3.04; I² = 70.3%). The evidence supports a selective, protocol-aware use of recruitment rather than routine aggressive application in unselected ARDS