The application of a high sustained airway pressure is not without potential problems. Hemodynamic compromise and the development of barotrauma are always concerns. Clearly, in patients with preexisting pulmonary cystic or bullous lung disease or preexisting airleaks, the benefits and potential risks of RMs must be carefully weighed. It is important to note that the groups reporting the use of RMs in either patients or animals have not reported the development of barotrauma. However, it must be assumed that as RMs become more and more common, examples of barotrauma will be reported.
Hemodynamic compromise is always a potential problem during positive pressure ventilation.
RMs should be delayed until patients are hemodynamicly stable. During any RM, arterial pressure, pulse rate and rhythm, and SpO 2 should be carefully monitored, and the recruitment maneuver aborted if compromise develops. I O 2 should be increased to 1.0 for 5-10 minutes before the RM is attempted. In addition, for patients to tolerate the high sustained pressure, they generally require sedation to insure passive inflation during the recruitment period. Since each patients pathology is different, it can be anticipated that individual patients may respond to different recruiting pressures.