Lung recruitment in patients with mixed lung diseases

Might recruitment in patients with mixed lung diseases result in an over-expansion of the non-collapsed area, instead of re-aerating the collapsed area?

It is true that in a patient with ARDS and COPD, it is impossible to assess recruitability with a P/V curve, because the hysteresis is large anyway due to long time-constant units. COPD is considered a contraindication for assessing recruitability.

Attempting lung recruitment using recruitment maneuvers carries the risk of complications and may not be efficient.

For these patients, the best solution may be to use prone positioning and a low PEEP strategy. However there is no data available to validate the use of prone positioning.