Recent changes were introduced in
acute hypoxemic respiratory failure children ventilation methods. There are evidences that less aggressive ventilation strategies can improve severe
pulmonary injury survival. Experimental trials evidenced a relationship between inappropriate ventilatory measures and delayed acute
pulmonary injury improvement, or even worsening. From this, a protective ventilatory measure arises in combination with alveolar recruitment maneuver. This association is believed in clinical practice to determine importantly reduced morbidity and mortality as well as reduced mechanic ventilation-induced
injuries. It is indicated for
acute lung injury patients, generally from
pneumonia or
sepsis, with severe
hypoxemia. Its main
contraindications are homodynamic instability,
pneumothorax and
intracranial hypertension. Experimental trials showed beneficial maneuver effects on both oxygenation and alveolar collapse. Adult studies showed improved pulmonary function with
hypoxemia reversion. In children, the maneuver lead to significant inspired
oxygen fraction and alveolar collapse reductions, less
oxygen dependency, improved pulmonary complacency, and reduced
bronchopulmonary dysplasia. However, studies in children are limited. Additional investigation is warranted on this matter, and its clinical application evidence. A literature review was conducted based on textbooks and MEDLINE, Pubmed, Cochrane library, SciELO, and Ovid databases, from 1998 to 2009, both in Portuguese and English. Publications on alveolar recruitment maneuver both in adults and children, review articles, experimental and clinical trials were included using the key words: protective ventilatory strategy, alveolar recruitment maneuver, pediatrics and mechanic ventilation.