The new development of recruitment maneuvers and the determination of the best "positive end-expiratory pressure" in acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is a life-threatening syndrome. Although the low-tidal-volume lung protective strategy has been proven to improve prognosis, it is still unable to manage all the patients with ventilator-associated lung injury. Accumulating evidence has shown that the recruitment maneuvers can improve the oxygenation in these patients based on the pathophysiology of ARDS. Herein, we review the evolvement and recent advance of the alveolar recruitment maneuvers and the various approaches to determine the optimal postexpiratory positive pressure following recruitment. We also introduce a non-invasive, real-time and bed-side used alveolar ventilation monitor, the electrical impedance tomography.