Recruitment maneuvers have been increasingly used to reverse the alveolar derecruitment associated with low tidal volume ventilation in patients with acute lung injury and acute respiratory distress syndrome. We report a case of improved oxygenation without hypotension or lung rupture, due to an early application of recruitment maneuvers (40 cmH₂O of continuous positive airway pressure for 40 s, three times [at 4.5 h, 5 h, 7 h], guided by pulse oximetry) followed by a mechanical pressure controlled ventilation with 20 cmH₂O of positive end-expiratory pressure in acute lung injury after femoral intramedullary nailing.