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Objective:

To present the use of a novel high-pressure recruitment maneuver followed by high levels of positive end-expiratory pressure in a patient with the acute respiratory distress syndrome (ARDS).

Design:

Observations in one patient.

Setting:

The medical intensive care unit at a tertiary care university teaching hospital.

Patient:

A 32-yr-old woman with severe ARDS secondary to streptococcal sepsis.

Interventions:

The patient had severe gas exchange abnormalities because of acute lung injury and marked lung collapse. Attempts to optimize recruitment based on the inflation pressure-volume (PV) curve were not sufficient to avoid dependent lung collapse. We used a recruitment maneuver using 40 cm H 2 O of positive end-expiratory pressure (PEEP) and 20 cm H 2 O of pressure controlled ventilation above PEEP for 2 mins to successfully recruit the lung. The recruitment was maintained with 25 cm H 2 O of PEEP …