Alveolar recruitment in acute respiratory distress syndrome: should we open the lung (no matter what) or may accept (part of) the lung closed?

  • Lorenzo Del Sorbo
  • Tommaso Tonetti
  • V. Marco RanieriEmail author
What's New in Intensive Care
The conceptual model of acute respiratory distress syndrome (ARDS) includes: (a) lung inflammation; (b) severe hypoxemia; (c) edema, hyaline membranes, and alveolar hemorrhage. Common denominator is the loss of aerated lung tissue due to alveolar collapse. To open collapsed alveoli has been, therefore, proposed to restore gas exchange [ 1] with interventions such as positive end-expiratory pressure (PEEP), recruitment maneuvers, and prone position [ 2]. Moreover, loss of lung volume may contribute to ventilator-induced lung injury (VILI) [ 2]. We will review the physiology of alveolar recruitment and address the implications of the “full recruitment” vs “partial recruitment” approaches (Fig.  1).



The funding has been received from Ministero dell’Università e della Ricerca with Grant No. (2017J4BE7A) PRIN 2017.

Compliance with ethical standards

Conflicts of interest

Authors declare no conflict of interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Interdepartmental Division of Critical Care Medicine, University Health NetworkUniversity of TorontoTorontoCanada
  2. 2.Department of Anesthesiology, Emergency and Intensive Care MedicineUniversity of GöttingenGöttingenGermany
  3. 3.Department of Anesthesia and Intensive CareParma University HospitalParmaItaly
  4. 4.Anesthesia and Intensive Care Medicine, Alma Mater Studiorum University of BolognaPoliclinico di Sant’OrsolaBolognaItaly

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