After a recruitment maneuver in a 10-year-old with ARDS, if SpO2 falls back down, what should be the next step?

In the context of managing a pediatric patient with Acute Respiratory Distress Syndrome (ARDS), the appropriate action after observing a decrease in SpO2 following a recruitment maneuver is to repeat the recruitment maneuver. Recruitment maneuvers are implemented to open collapsed alveoli that contribute to shunting and impaired gas exchange. If SpO2 levels fall again after an initial improvement, it indicates that the lung recruitment achieved may have been insufficient or temporary.

Repeating the recruitment maneuver can help to sustain or further improve lung recruitment, potentially leading to better ventilation-perfusion matching and increased oxygenation. This can be particularly important in ARDS, where maintaining adequate oxygen levels is crucial to ensure organ function and overall patient stability.

Increasing PEEP or FiO2, while potentially beneficial in some scenarios, may not address the underlying issue of collapsed alveoli and can sometimes lead to further complications. Decreasing inspiratory time generally would not enhance oxygenation and may lead to inadequate ventilation. Therefore, the most logical and effective next step is to repeat the recruitment maneuver to optimize lung function and improve oxygenation.