Meta Titular

CochraneDatabaseof SystematicReviews
Recruitment manoeuvresfor adultswithacuterespiratory

distresssyndromereceivingmechanical ventilation(Review)
Hodgson C, Goligher EC, YoungME, KeatingJ L, Holland AE, Romero L, BradleySJ , Tuxen D
R3MI ALBERTO MONROY CHARGOY
* Las maniobras de reclutamiento implican elevaciones
transitorias en la presin de las vas respiratorias aplicadas

durante la ventilacin mecnica para abrir las unidades
pulmonares colapsadas y aumentar el nmero de alvolos que
participan en la ventilacin de las mareas.
* PRIMARIO
* Determinar los efectos de las maniobras de reclutamiento en
la mortalidad en px con ARDS.
* SECUNDARIO
* Determinar los efectos de esta maniobras en la oxigenacin y
efectos adversos.
*OBJETIVOS
Study
Mode
Peak pressure
(cmH2O)
Time
(sec)
PEEP titration dif- Mean PEEP after Repetitions

fered
between RM
groups
(cmH2O)
Cavalcanti et al, PCV

60 (delivered in- 240
Yes
Ta
ble1. Description of recruitm
entlly)
manoeuvreprocedure (Continued)
2013
crementa
Hodgson 2011
PCV
55 (delivered in- 360
Yes
16.1
Daily (+after desaturationordisconnection)
17.4
Daily (+after desat-
Recruitment manoeuvres for adults with acute respiratory distresssyndrome receiving mechanical ventilation (Review)
43
ntally) Published by John Wiley & Sons, Ltd.
urationordisconnecCopyright 2016 The Cochranecreme
Collaboration.
tion)
Huh 2009
VCV
55(deliveredin- NS
crementally to 25
cm H 2O PEEP
with decremental
tidal volume setting)
Yes
10
Daily (+after desaturationordisconnection)
Kacmarek 2016
PCV
60 depending 120
ontheparticipants
response (delivered incrementally
to PEEP 35 to 45
cmH 2O)
Yes
15.8
NS
Liu 2011
NS
NS
NS
Yes
NS
NS
Meade2008
PCV
40
40
Yes
14.6
Frequently after disconnection
Oczenski 2004
PCV
50
30
No
15.1
Once
Wang2009
BIPAP
NS
NS
N/A
NS
Eight-hourly
Xi 2010
CPAP
40 (cm
CPAP)
H 2O 40
No
10.5
Eight-hourly
Yang2011
CPAP
40 (cm
CPAP)
H 2O 30
No
NS
Eight-hourly
*ESTUDIOS.
Huh 2009 - RM with incremental and decremental titration cycled twiceover 10 minutes.
BIPAP =bi-level positive airway pressure; CPAP =continuous positive airway pressure; NS =not stated; PCV =pressure-cycled
ventilation; sec =seconds; VCV =volume-cycled ventilation.
Day mortality.
Review: Recruitment manoeuvres for adults with acute respiratory distresssyndrome receivingmechanical ventilation
Analysis 1.1. Comparison 1 Recruitment manoeuvres versus no recruitment manoeuvres, Outcome 1 28Day mortality.
Comparison: 1 Recruitment manoeuvres versus no recruitment manoeuvres
Outcome: 1 28-Day mortality

Review: Recruitment manoeuvresfor adultswith acute respiratory distresssyndrome receivingmechanical ventilation
Comparison:
1 Recruitment manoeuvres
versusno recruitment
manoeuvres
Study or subgroup
Intervention
Control
n/N
Outcome: 1 28-Day mortality
n/N
Risk Ratio
Weight
M-H,Fixed,95%CI
Risk Ratio
M-H,Fixed,95%CI
1 Open lungventilation includingrecruitment manoeuvres

Studyor
Huh
2009 subgroup
Kacmarek 2016
Intervention
12/30
Control
9/27
n/N
22/99
n/N
27/101
Weight4.0 %
Risk[Ratio
1.20
0.60, 2.39 ]
11.3 %
M-H,Fixed,95%CI
0.83 [ 0.51, 1.36 ]
17/50
9/27
7.2 %
4.0 %
0.82 [ 0.46, 1.48 ]

1.20 [ 0.60, 2.39 ]
135/475
22/99
164/508
27/101
67.2 %
11.3 %
0.88 [ 0.73, 1.06 ]

0.83 [ 0.51, 1.36 ]
654
686
89.8%
0.88[ 0.75, 1.04 ]

Liu 2011
14/50
Huh 2009
12/30
Meade 2008
Kacmarek 2016
Subtotal (95% CI)
Risk Ratio
M-H,Fixed,95%CI
Liu 2011
14/50
17/50
Total events: 183 (Intervention), 217 (Control)
Meade 2008 2 = 0.87, df = 3 (P =0.83);
135/475I2 =0.0% 164/508
Heterogeneity:Chi
Test
for overall
efect:CI)
Z =1.47 (P = 0.14) 654
Subtota
l (95%
7.2 %
686
0.82 [ 0.46, 1.48 ]
67.2 %
0.88 [ 0.73, 1.06 ]
89.8 %
0.88 [ 0.75, 1.04]
2 Recruitment
manoeuvres
Total events: 183
(Intervention), 217 (Control)
Xi 2010
16/55
2 = 0.87, df = 3 (P =0.83);
Heterogeneity:Chi
I2 =0.0%
24/55
10.2 %
0.67 [ 0.40, 1.11 ]
55
10.2%
0.67[ 0.40, 1.11 ]
Test for overall

efect:
Z =1.47 (P = 0.14) 55
Subtota
l (95%
CI)
2 Recruitment
manoeuvres 24 (Control)
Total
events: 16 (Intervention),
Xi 2010
16/55
Heterogeneity:not
applicable
24/55
Test
for overall
efect:CI)
Z =1.56 (P = 0.12)
Subtota
l (95%
55
Tota
l
(95%
CI)
709
10.2 %
55
741
10.2 %
100.0%
0.67 [ 0.40, 1.11 ]
0.67 [ 0.40, 1.11]

0.86[ 0.74, 1.01 ]
Total
events: 199 (Intervention),
Heterogeneity:not
applicable 241 (Control)
Heterogeneity:Chi
=Z
1.95,
df =(P4=
(P0.12)
=0.75); I2 =0.0%
Test for overall ef2ect:
=1.56
Test
forloverall
ect: Z =1.86 (P = 0.063)709
Tota
(95%efCI)
741
2 =1.06,
Total
199dif
(Intervention),
(Control)
Test
forevents:
subgroup
erences: Chi241
df =1 (P = 0.30), I2
100.0 %
=6%
Heterogeneity:Chi2 = 1.95, df = 4 (P =0.75); I2 =0.0%

Test for overall efect: Z =1.86 (P = 0.063)
Test for subgroup diferences:Chi2
=1.06, df =1 (P = 0.30), I2
0.2
=6%
0.5
Favours intervention
Favours control
0.86 [ 0.74, 1.01]
Comparison: 1 Recruitment manoeuvresversus no recruitment manoeuvres
Analysis 1.2. Comparison 1 Recruitment manoeuvres versus no recruitment manoeuvres, Outcome 2 ICU
Outcome: 2 ICU mortality
mortality.
Review:
Recruitm
ent manoeuvresforIntervention
adultswith acute respiratory
distresssyndrome receivingmechanical
ventilation
Studyor
subgroup
Control
Risk Ratio
n/Nno recruitment manoeuvres
n/N
Comparison: 1 Recruitment manoeuvresversus
Outcome:
2 ICU mortality
Hodgson 2011
3/10
Huh
Study
or 2009
subgroup
13/27
Control
n/N
25/99
n/N
30/101
Kacmarek 2016
1 OpenMeade
lungventilation
includingrecruitment
manoeuvres
2008
145/475
Hodgson 2011
Subtotal (95% CI)
3/10
= 0.60, df = 3 (P =0.90); I2
Kacmarek 2016
25/99
Meade
2008 manoeuvres
2 Recruitment
M-H,Fixed,95%CI
0.8 %
1.50 [ 0.32, 7.14 ]
5.6 %
Weight
0.97 Risk
[ 0.56,
1.68 ]
Ratio
12.1 %
M-H,Fixed,95%CI
0.85 [ 0.54, 1.34 ]
69.8 %
0.87 [ 0.73, 1.04 ]
0.8 %
646
88.2%
1.50 [ 0.32, 7.14 ]
0.88 [ 0.75, 1.03 ]
13/27
5.6 %
0.97 [ 0.56, 1.68 ]
=0.0%
30/101
12.1 %
0.85 [ 0.54, 1.34 ]
178/508
69.8 %
0.87 [ 0.73, 1.04 ]
145/475
Xi 2010
Risk Ratio
2/10
614
Risk Ratio
M-H,Fixed,95%CI
178/508
Total2009
events:187 (Intervention), 223 (Control)
Huh
14/30
Heterogeneity:Chi2
M-H,Fixed,95%CI
2/10
14/30
Intervention
Weight
18/55
Subtotal (95% CI)

614
ubtota
l (95%
CI) 223 (Control) 55
TotalSevents:
187
(Intervention),
646
55
29/55
88.2%
11.8%
11.8 %
0.88 [ 0.75, 1.03]

0.62 [ 0.39, 0.98 ]
0.62 [ 0.39, 0.98 ]
701
29/55
100.0%
11.8 %
0.85
[ [0.73,
0.99
0.62
0.39, 0.98
] ]
Total events:18
(Control)I2 =0.0%
Heterogeneity:
Chi2 (Intervention),
= 0.60, df = 3 29
(P =0.90);
TestHeterogeneity:not
for overall efect: Zapplicable
= 1.57 (P = 0.12)
Test for overall
efect: Z =2.06 (P = 0.040)
2 Recruitment
manoeuvres
Tota
l (95% CI)
669
Xi
2010
18/55
Total events:205 (Intervention), 252 (Control)
Subtota
l (95% CI)
55
55
11.8%
0.62 [ 0.39, 0.98]
100.0%
0.85 [ 0.73, 0.99]

Heterogeneity:
not applicable
Test for subgroup diferences: Chi2 =2.02, df =1 (P = 0.15), I2 =51%
Test for overall efect: Z = 2.06 (P = 0.040)
Total (95% CI)
669

Heterogeneity: Chi2 = 2.64, df = 4 (P =0.62); I2 =0.0%
701
0.01
0.1
10
100
Favours control
Analysis
1.3.
Comparison
1 Recruitment
manoeuvres
versus no recruitment manoeuvres, Outcome 3 InComparison:
1 Recruitment
manoeuvres
manoeuvres
hospital mortality.
Outcome: 3 In-hospital mortality

Studyor subgroup
Intervention
Control
n/N
n/N
Comparison: 1 Recruitment manoeuvresversusno recruitment manoeuvres
Risk Ratio
Weight
M-H,Fixed,95%CI
Risk Ratio
M-H,Fixed,95%CI
Outcome: 3 In-hospital mortality

Hodgson 2011
3/10
2/10
Studyor
subgroup
Kacmarek 2016
Intervention
29/99
Control
35/101
n/N
Meade 2008
n/N
173/475
Subtotal (95% CI)
M-H,Fixed,95%CI
205/508
584
Hodgson 2011
Risk Ratio
2/10
Meade 2008
173/475
Xi 2010
Subtota
l (95% CI)
Weig
ht
13.0 %
0.85 [ 0.56, 1.27 ]
205/508
Risk Ratio
M-H,Fixed,95%CI
0.90 [ 0.77, 1.06 ]
88.3%
0.90 [ 0.78, 1.04]
13.0 %
0.85 [ 0.56, 1.27 ]
74.5 %
0.90 [ 0.77, 1.06 ]
0.8 %
2 = 0.50, df = 2 (P = 0.78); I2 =0.0%

Heterogeneity:Chi
Kacmarek
2016
29/99
35/101
Test for overall efect:Z =1.41 (P = 0.16)
1.50 [ 0.32, 7.14 ]
74.5 %
619
3/10
0.8 %
1.50 [ 0.32, 7.14 ]
23/55
584
31/55
619
11.7 %
88.3%
[ 0.50,
1.09 ]
0.90 [0.74
0.78,
1.04]
TotalSevents:
205
(Intervention),
ubtota
l (95%
CI) 242 (Control) 55
55
11.7%
0.74 [ 0.50, 1.09]
674
31/55
100.0%
11.7 %
0.880.74
[ 0.77,
1.01]
[ 0.50,
1.09 ]
55
11.7%
0.74 [ 0.50, 1.09]
100.0%
0.88 [ 0.77, 1.01]
2 = 0.50, df = 2 (P =0.78); I2 =0.0%

Heterogeneity:Chi
Total events: 23 (Intervention),
31 (Control)
TestHeterog
for overall
efect: Zapplicable
=1.41 (P = 0.16)
eneity:not
Test for overall
efect:Z =1.50 (P = 0.13)
2 Recruitment
manoeuvres
l (95% CI)
XiTota
2010
639
23/55
Subtota
l (95% CI)
55
Heterogeneity:Chi2 = 1.32, df = 3 (P = 0.72); I2 =0.0%
TotalTest
events:
23 (Intervention),
31 (Control)
for overall
efect:Z =1.80
(P = 0.072)
Heterogeneity:not
applicable
Test for subgroup
diferences: Chi2 =0.82, df =1 (P = 0.37), I2 =0.0%
Total (95% CI)
639
674

Heterogeneity:Chi2
= 1.32, df = 3 (P =0.72); I2
0.01
0.1
=0.0%

Test for subgroup diferences:Chi2 =0.82, df =1 (P = 0.37), I2 =0.0%
10
100
Favours control
AnalysisComparison:
1.4. Comparison
1 Recruitment
manoeuvres
manoeuvres versus no recruitment manoeuvres, Outcome 4 Rate
of barotrauma.
Outcome: 4 Rate of barotrauma

Studyor subgroup
Intervention
Control
Risk Ratio
Comparison: 1 Recruitment manoeuvresversus no

n/Nrecruitment manoeuvres
n/N
Weight
M-H,Fixed,95%CI
Risk Ratio
M-H,Fixed,95%CI
1 Open
lungventilation
Outcome: 4
Rate of
barotraumaincludingrecruitment manoeuvres
Hodgson 2011
Huh 2009
Studyor subgroup
0/10
0/10
Intervention
3/30
Control 3/27
n/N
6/99
n/N 8/101
Kacmarek 2016
Liu 2011includingrecruitment manoeuvres

2/50
1 Open lungventilation
Hodgson 2011
Meade 2008
Yang2011
Huh 2009
Subtotal (95% CI)
5.2
% ht
Weig
Risk Ratio
M-H,Fixed,95%CI
13.1 %
4/50
6.6 %
0/10 53/475
0/10
47/508
75.1 %
0/19
3/27 0/19
3/30
Kacmarek 2016
Not estimable
6/99
683
8/101
5.2 %
715
100.0%
13.1 %
2
(P =0.65); I2 =0.0%4/50
Liu 2011 Heterogeneity:Chi = 1.66, df = 32/50
0.90 [ 0.20, 4.09

] Ratio
Risk
0.77 [M-H,Fixed,95%CI
0.28, 2.13 ]
0.50 [ 0.10, 2.61 ]
Not
estimable
1.21 [ 0.83,
1.75
]
Not
estim
able 4.09 ]
0.90
[ 0.20,
1.09[ 0.78, 1.51]
0.77 [ 0.28, 2.13 ]
6.6 %
0.50 [ 0.10, 2.61 ]
75.1 %
1.21 [ 0.83, 1.75 ]
Meade 2008
Yang2011
53/475
Xi 2010
0/19
47/508
0/55
Subtotal (95% CI)
55
Subtotal (95%
CI)0 (Intervention), 0 (Control)
683
Total events:
0/19
715
0/55
Not estimable
55
Notestimable
Not estimable
100.0 %
1.09[ 0.78, 1.51 ]
Total events: 64
(Intervention),
62 (Control)
Heterog
eneity:not applicable
2=
Test for
overall
ect:
applicable
Heterogeneity:Chi
1.66,efdf
=not
3 (P
=0.65); I2 =0.0%
Tota
l (95%
CI)(P = 0.63)
Test for overall
efect:
Z =0.49
738
770
100.0%
1.09[ 0.78, 1.51]
Xi 2010 Test for overall efect: Z =0.49 (P0/55

= 0.63)
Test for subgroup diferences:Not applicable

Subtotal (95%
CI)
55

Heterogeneity:not applicable
0/55
Not estimable
55
Not estimable
0.01
0.1
10
100
Favours control
Analysis 1.5. Comparison 1 Recruitment manoeuvres versus no recruitment manoeuvres, Outcome 5 Use
of rescue therapies.
Analysis 1.5. Comparison 1 Recruitment manoeuvres versus no recruitment manoeuvres, Outcome 5 Use
Review: Recruitment manoeuvresfor adults with acute respiratory
distresssyndrome
receivingmechanical ventilation
of rescue
therapies.
Comparison: 1 Recruitment manoeuvres versusno recruitment manoeuvres
Outcome: 5 Use of rescue therapies
Comparison: 1 Recruitment manoeuvres versusno recruitment manoeuvres

Outcome:
Use of rescue therapies
Study or 5
subgroup
Intervention
Control
n/N
Intervention
n/N
Control
0/10
2/10
n/N
16/30
n/N
13/27
0/10
2/10
Study or subgroup
Hodgson 2011
Huh 2009
Hodgson 2011
Meade 2008
22/475
Huh 2009
Total (95% CI)
16/30
515
Total events:
(Control)
Meade
2008 38 (Intervention), 67 22/475
Heterogeneity: Tau2
Total (95% CI)
=0.35; Chi2
Weight
Risk Ratio
MH,Random,95%
CI
Weight
7.5 %
45.8 %
7.5 %
52/508
46.7 %
13/27
45.8 %
545
100.0%
52/508
= 7.63, df = 2 (P = 0.02); I2
515
Risk Ratio
MH,Random,95%
CI
=74%
545
Test for subgroup diferences: Not applicable
Heterogeneity:Tau2 =0.35; Chi2 = 7.63, df = 2 (P = 0.02); I2 =74%

Test for subgroup diferences: Not applicable
0.01
0.1
0.01
0.1
10
100
Favours control
10
100
Favours control
Risk Ratio
MH,Random,95%
CI
Risk Ratio
0.20 [ 0.01, 3.70M]
H,Random,95%
CI
1.11 [ 0.66, 1.85 ]
0.20 [ 0.01, 3.70 ]
0.45 [ 0.28, 0.73 ]
1.11 [ 0.66, 1.85 ]
0.64 [ 0.27, 1.51 ]
46.7 %
0.45 [ 0.28, 0.73 ]
100.0%
0.64 [ 0.27, 1.51]
Review: Recruitment manoeuvres for adultswith acute respiratory distresssyndrome receivingmechanical ventilation
Comparison: 1 Recruitment manoeuvresversusno recruitment manoeuvres
Analysis
1.6. Comparison 1 Recruitment manoeuvres versus no recruitment manoeuvres, Outcome 6
Outcome: 6 PaO 2/FiO 2 ratio at 24 to 48 hours
PaO2/FiO2 ratio at 24 to 48 hours.
Mean ventilation
Review: Recruitment manoeuvresfor adults with acute respiratory distresssyndrome receivingmechanical
Studyor subgroup
Control
Intervention
Diference
N
Mean(SD)
N
Mean(SD)
Comparison: 1 Recruitment manoeuvres
versus
no recruitment manoeuvres
Weight
IV,Random,95%CI
Mean
Diference
IV,Random,95%CI
1 Open lungventilationincludingrecruitment manoeuvres
Outcome: 6 PaO 2/FiO 2 ratio at 24 to 48 hours

Cavalcanti et al, 2013
54
143.3 (46.8)
47
179.5 (84.5)
Hodgson 2011
10
140 (28)
10
230 (36.1)
Control 27 137.3 (49.3)Intervention 30

N
Mean(SD)
N
160.9 (65.2)
Studyor
subgroup
Huh
2009
Meade 2008
498
149.1 (60.6)
464
1 Open lungventilationincludingrecruitment manoeuvres

Wang2009
Cavalcanti et al, 2013
Subtotal (95% CI)
54
10
183 (49.3)
143.3 (46.8)
599
47
Mean
Diference
Mean(SD)
10 206.4 (114.1)
561
179.5 (84.5)
27
MeadeXi
2008
2010
137.3 (49.3)
498 55
149.1 (60.6)
125 (46)
Subtotal (95% CI) 10 55183 (49.3)

Wang2009
Subtota
(95%
599 (P = 0.099)
Testlfor
overallCI)
efect: Z =1.65
Heterogeneity:Tau2
=369.07; Chi2
Total (95% CI)
30
-90.00 [ -118.32, -61.68 ]
Mean
Dif
erence
-23.60 [ -53.44,
6.24
]
IV,Random,95%CI
25.5 %
-38.30 [ -46.52, -30.08 ]
4.8 %
-23.40 [ -100.44, 53.64 ]
-36.20 [ -63.39, -9.01 ]
79.6% -44.76[ -66.29, -23.22]
160.9 (65.2)
464 55 187.4142
(68.8)
(61)
1055206.4 (114.1)
561
16.5 %
-90.00 [ -118.32, -61.68 ]
15.8 %
-23.60 [ -53.44, 6.24 ]
25.5%
%
20.4
-38.30
-46.52,3.19
-30.08
-17.00 [ -37.19,
] ]
20.4%
4.8 %
-17.00[
-37.19,
3.19]
-23.40
[ -100.44,
53.64 ]
79.6% -44.76[ -66.29, -23.22 ]
= 13.53, df = 4 (P = 0.01); I2
654
16.5 %
17.0 %
Hodgson
2011
10 Chi2 =140
(28)
10I2 =70%
230 (36.1)
Heterog
eneity:Tau2 =369.07;
13.53,
df = 4 (P =0.01);
Huh 2009
-36.20 [ -63.39, -9.01 ]
Weig
ht
15.8 %
IV,Random,95%CI
187.4 (68.8)
17.0 %
=70%
616
100.0% -39.10[ -57.64, -20.56]
2 =333.30;
2 = 18.16, df = 5 (P =0.003); I2 =72%
Test forHeterog
overalleneity:Tau
efect:Z =4.07
(P =Chi
0.000046)
Test for overall

efect: Z =4.13 (P = 0.000036)
2 Recruitment
manoeuvres
2
Test for subgroup diferences:
df =1 (P = 0.07),55
I2 =71% 142 (61)
Xi 2010
55Chi =3.40,
125 (46)
Subtotal (95% CI)
55
55
654
-50
Test for overall efect:Z =1.65 (P = 0.099)
Total (95% CI)
-100
616
50
100
20.4 %
-17.00 [ -37.19, 3.19 ]
20.4%
-17.00 [ -37.19, 3.19 ]
Favours control
100.0% -39.10[ -57.64, -20.56 ]

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CochraneDatabaseof SystematicReviews

Recruitment manoeuvresfor adultswithacuterespiratory

R3MI ALBERTO MONROY CHARGOY

* Las maniobras de reclutamiento implican elevaciones

transitorias en la presin de las vas respiratorias aplicadas

PEEP titration dif- Mean PEEP after Repetitions

Cavalcanti et al, PCV

55 (delivered in- 360

Daily (+after desaturationordisconnection)

Daily (+after desat-

Daily (+after desaturationordisconnection)

Frequently after disconnection

Comparison: 1 Recruitment manoeuvres versus no recruitment manoeuvres

Outcome: 1 28-Day mortality

Outcome: 1 28-Day mortality

1 Open lungventilation includingrecruitment manoeuvres

0.82 [ 0.46, 1.48 ]

0.88 [ 0.73, 1.06 ]

0.88[ 0.75, 1.04 ]

1 Open lungventilation includingrecruitment manoeuvres

Subtotal (95% CI)

0.82 [ 0.46, 1.48 ]

0.88 [ 0.73, 1.06 ]

0.88 [ 0.75, 1.04]

0.67 [ 0.40, 1.11 ]

0.67[ 0.40, 1.11 ]

Test for overall

0.67 [ 0.40, 1.11 ]

0.67 [ 0.40, 1.11]

Heterogeneity:Chi2 = 1.95, df = 4 (P =0.75); I2 =0.0%

0.86 [ 0.74, 1.01]

Comparison: 1 Recruitment manoeuvresversus no recruitment manoeuvres

Subtotal (95% CI)

1.50 [ 0.32, 7.14 ]

0.87 [ 0.73, 1.04 ]

1.50 [ 0.32, 7.14 ]

0.88 [ 0.75, 1.03 ]

0.97 [ 0.56, 1.68 ]

0.85 [ 0.54, 1.34 ]

0.87 [ 0.73, 1.04 ]

Subtotal (95% CI)

0.88 [ 0.75, 1.03]

0.62 [ 0.39, 0.98 ]

0.62 [ 0.39, 0.98]

0.85 [ 0.73, 0.99]

Total events: 18 (Intervention), 29 (Control)

Total (95% CI)

Total events: 205 (Intervention), 252 (Control)

Review: Recruitment manoeuvresfor adultswith acute respiratory distresssyndrome receivingmechanical ventilation

Comparison: 1 Recruitment manoeuvresversusno recruitment manoeuvres

Outcome: 3 In-hospital mortality

1 Open lungventilation includingrecruitment manoeuvres

Subtotal (95% CI)

1 Open lungventilation includingrecruitment manoeuvres

Total events: 205 (Intervention), 242 (Control)

0.85 [ 0.56, 1.27 ]

0.90 [ 0.78, 1.04]

0.85 [ 0.56, 1.27 ]

0.90 [ 0.77, 1.06 ]

2 = 0.50, df = 2 (P = 0.78); I2 =0.0%

Test for overall efect:Z =1.41 (P = 0.16)

1.50 [ 0.32, 7.14 ]

1.50 [ 0.32, 7.14 ]

0.74 [ 0.50, 1.09]