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. 2021 Jun 4:12:666941.
doi: 10.3389/fphys.2021.666941. eCollection 2021.

Assessment of the Effect of Recruitment Maneuver on Lung Aeration Through Imaging Analysis in Invasively Ventilated Patients: A Systematic Review

Charalampos Pierrakos  1   2 , Marry R Smit  1 , Laura A Hagens  1 , Nanon F L Heijnen  3 , Markus W Hollmann  4   5 , Marcus J Schultz  1   4   6   7 , Frederique Paulus  1 , Lieuwe D J Bos  1   4   8
Affiliations

Assessment of the Effect of Recruitment Maneuver on Lung Aeration Through Imaging Analysis in Invasively Ventilated Patients: A Systematic Review

Charalampos Pierrakos et al. Front Physiol. .

Abstract

Background: Recruitment maneuvers (RMs) have heterogeneous effects on lung aeration and have adverse side effects. We aimed to identify morphological, anatomical, and functional imaging characteristics that might be used to predict the RMs on lung aeration in invasively ventilated patients. Methods: We performed a systemic review. Studies included invasively ventilated patients who received an RM and in whom re-aeration was examined with chest computed tomography (CT), electrical impedance tomography (EIT), and lung ultrasound (LUS) were included. Results: Twenty studies were identified. Different types of RMs were applied. The amount of re-aerated lung tissue after an RM was highly variable between patients in all studies, irrespective of the used imaging technique and the type of patients (ARDS or non-ARDS). Imaging findings suggesting a non-focal morphology (i.e., radiologic findings consistent with attenuations with diffuse or patchy loss of aeration) were associated with higher likelihood of recruitment and lower chance of overdistention than a focal morphology (i.e., radiological findings suggestive of lobar or segmental loss of aeration). This was independent of the used imaging technique but only observed in patients with ARDS. In patients without ARDS, the results were inconclusive. Conclusions: ARDS patients with imaging findings suggestive of non-focal morphology show most re-aeration of previously consolidated lung tissue after RMs. The role of imaging techniques in predicting the effect of RMs on re-aeration in patients without ARDS remains uncertain.

Keywords: ARDS; computed tomography; electrical impedance tomography; lung ultrasound; overdistention; recruitment maneuvers.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the study selection.
Figure 2
Figure 2
The proportions of lung recruitment and lung overdistention in patients who were characterized responders or not responders to lung recruitment maneuvers (RM) based on computed tomography findings.
Figure 3
Figure 3
Imaging abnormalities that predicted response to recruitment maneuvers (RM) stratified per morphology. LUS, lung ultrasound; EIT, electrical impedance tomography; CT, computed tomography; HU, Houndsfield units; green, imaging abnormality in line with responder to RM; red, imaging abnormality in line with non-responder to RM; orange, imaging abnormality in line with responder with high uncertainty. Text boxes on the left: consistent with non-focal morphology. Text boxes on the right: consistent with focal morphology.
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