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Patients with early moderate to severe Acute Respiratory Distress Syndrome (ARDS) may benefit from a strategy aimed at opening collapsed alveoli, improving oxygenation and reducing driving pressure by using high-sustained airway pressurization, under careful ventilatory and hemodynamic monitoring. This maneuver is known as Maximum Recruitment Maneuver (MRM). This video presents the technique as suggested by the Brazilian Recommendations on Mechanical Ventilation and including the decremental PEEP titration in Volume Controlled Ventilation - VCV. It is essential that expert physicians, respiratory therapists and nurses perform this maneuver only in carefully selected patients in the intensive care setting and with close supervision at the bedside. This video is an accelerated simulation of the entire process, which usually takes 30 minutes to 1 hour to be properly execute.

References:
     Barbas CSV, Ísola AM, Farias AMC, Cavalcanti AB, Gama AMC, Duarte ACM, et al. Brazilian recommendations of mechanical ventilation 2013. Part I. Rev Bras Ter Intensiva. 2014;26(2):89-121.