What question did this study set out to answer?

This study aims to explore how recruitment maneuvers and PEEP titration affect dead space in ARDS patients.

April 3, 2026Open Access

The Effect of Recruitment Maneuvers on Dead Space in Patients with ARDS: Prospective Observational Study

AEAyla EsinIstanbul University-Cerrahpaşa TUTuğhan UtkuYeditepe University ODOktay DemirkiranIstanbul University-Cerrahpaşa

Key Points

This study aims to explore how recruitment maneuvers and PEEP titration affect dead space in ARDS patients.
Prospective observational design involving twelve early-phase ARDS patients
Implementation of a standard recruitment maneuver protocol
Decremental PEEP titration after stabilization of patients
Measurements taken for dead space, lung mechanics, blood gases, and hemodynamics before and after intervention
Significant reduction in both airway and physiological dead space after recruitment maneuvers
Increased PaO₂ and oxygen saturation levels observed
Arterial pH decreased slightly while other parameters showed no significant change

Abstract

Objective: Acute Respiratory Distress Syndrome (ARDS) is characterized by severe hypoxemia and heterogeneous lung involvement. Recruitment maneuvers (RMs) and positive end-expiratory pressure (PEEP) titration are commonly employed strategies in lung-protective ventilation to reopen collapsed alveoli and improve oxygenation. However, the effect of these strategies on dead space—a key indicator of ventilation-perfusion mismatch—remains underexplored. This study aimed to investigate the impact of RMs and PEEP titration on dead space in patients with ARDS. Material and Method: This prospective observational study included twelve early-phase ARDS patients. After initial stabilization, each patient underwent a standard RM protocol followed by decremental PEEP titration. Dead space parameters, lung mechanics, blood gases, and hemodynamic variables were measured before and after RM and individualized PEEP titration. Results: A statistically significant reduction in both airway and physiological dead space was observed following RM. PaO₂ and oxygen saturation increased, while arterial pH decreased modestly. Alveolar dead space, compliance, airway pressures, end-tidal CO₂, and hemodynamics did not change significantly. Conclusion: Individualized ventilation strategies with RMs and PEEP may reduce physiological dead space and improve oxygenation in early ARDS without causing significant hemodynamic compromise. These findings suggest that incorporating dead space monitoring could be considered in personalized approaches to help optimize gas exchange and potentially improve clinical outcomes

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