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

When managing a patient with ARDS, particularly after performing a recruitment maneuver, it's critical to recognize that a decline in SpO2 indicates a potential failure to maintain adequate oxygenation. In this context, repeating the recruitment maneuver may be warranted for several reasons.

A recruitment maneuver is designed to open collapsed alveoli, thereby improving lung compliance and surface area for gas exchange. If SpO2 decreases after such an intervention, it suggests that the initial maneuver may not have been sufficient to maintain optimal lung recruitment or that atelectasis has recurred. By repeating the maneuver, there is a chance to further recruit those collapsed areas of the lung, improving ventilation-perfusion matching and enhancing overall oxygenation status more effectively.

This approach aims to maximize lung recruitment and ensure that the therapy is having a sustained benefit, especially in acute settings like ARDS where lung compliance can be fragile. It's a common strategy employed to manage dynamic changes in oxygenation following initial airway management techniques.

Increasing PEEP or FiO2, while helpful in some situations, does not directly address the potential need for ongoing recruitment of lung units. Decreasing inspiratory time could worsen ventilation if lung volumes are not adequately established. Thus, in this case, repeating the recruitment maneuver directly targets the underlying issue