This paper summarized the nursing experience of a child with total left lung atelectasis，fibrous plaque formation，and difficulty in weaning off the ventilator，who underwent respiratory therapy nurse-led lung recruitment maneuver treatment. In response to the child’s poor chest wall elasticity and susceptibility to atelectasis complications，a dual assessment system was used before the recruitment maneuver to assess lung recruitability and establish the child’s safe recruitment threshold. A combination of deep sedation, progressive recruitment maneuvers, and individualized PEEP titration ensured safety. Following programmed weaning and respiratory training, the child was extubated and discharged on day 18, with good follow-up outcomes.