Does standard opening of the lungs after intubation improve lung and heart function?

Invasive mechanical ventilation requires tracheal intubation. Intubation is facilitated by muscle paralysis, which could induce further atelectases. Atelectases compromise gas–exchange and depresses cardiac function. Early recruitment maneuvers (RMs) could resolve atelectases, but it is uncertain whether they should be applied in every intubated intensive care patient (i.e., early after intubation) or only in whom gas–exchange does not improve (i.e., only when necessary).
Therefore a strategy using early recruitment maneuvers (RMs) after intubation is compared with a strategy using RMs only on indication in intensive care patients. We hypothesize that early RMs homogenize and improve lung aeration and subsequently improves right ventricular function.

Early recruitment maneuvers (RMs) after intubation result in a reduction of atelectases and subsequently improved cardiac function in comparison with standard care

t0: Within 30 minutes after intubation but just before lung recruitment

t1: 1 hour after lung recruitment

t2: 24 hours after lung recruitment

Lung recruitment maneuvers after intubation: increasing driving pressure with steps of 10 cm H2O with an inspiratory hold of 10 seconds after each step. At a maximum of 40 cm H2O of driving pressure, PEEP is increased form 5cm H2O to 10cm H2O and the driving pressure decreased in steps of 10 cm H2O to 6-8ml tidal volume /kg lean body weight.
The standard care group will receive after intubation a similar driving pressure to obtain 6-8ml tidal volume /kg lean body weight, but with 5 PEEP and without lung recruitment (only on indication if hypoxia is present at the discretion of the attending physician