Table 1.

Recruitment and lung re-expansion maneuver steps

Recruitment maneuver

1. Increase FIO2 to 1.0 2. Set peak inspiratory pressure limit to 45 cmH2O 3. Set respiratory rate to six breaths/min 4. Set I:E ratio to 1:1 5. Increase VT in steps of approximately 2 mL/kg PBW until plateau pressure reaches 30–40 cmH2O 6. If the maximum VT allowed by the anesthesia ventilator is achieved and the plateau pressure is lower than 30 cmH2O, increase the PEEP as needed, to a maximum of 20 cmH2O 7. Allow three breaths while maintaining plateau pressure of 30–40 cmH2O 8. Set VT, PEEP, respiratory rate, and I:E ratio back to pre-recruitment values

Lung re-expansion maneuver

1. Keep the non-ventilated under visual inspection, whenever possible 2. Connect the CPAP device with adequate oxygen flow (FIO2 1.0) to the non-ventilated lung 3. Set CPAP to 10 cmH2O during 20 s 4. Set CPAP to 15 cmH2O during 20 s 5. Set CPAP to 20 cmH2O during 20 s 6. If performed as part of a rescue therapy for hypoxemia and oxygenation has been restored, reduce CPAP as soon as possible to 10 cmH2O, or 5 cmH2O, or disconnect the CPAP device

RM recruitment maneuver, F_IO₂ inspiratory fraction of oxygen, I:E ratio inspiratory to expiratory ratio, VT tidal volume, PBW predicted body weight, PEEP positive end-expiratory pressure, CPAP continuous positive airway pressure