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Optimal peep in ARDS. Changing concepts and current controversies.
1Medical Intensive Care Unit, Rhode Island Hospital, Brown University School of Medicine, Providence, Rhode Island, USA. Mitchell_Levy@brown.edu
Critical Care Clinics
|March 26, 2002
Summary
Optimal positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS) requires balancing lung overstretching and derecruitment. Current methods for titrating PEEP in ARDS patients are still under investigation.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Mechanical Ventilation
Background:
- A definitive criterion standard for optimal positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS) is lacking.
- Existing research highlights key considerations for PEEP titration in ARDS.
Purpose of the Study:
- To delineate the current understanding and challenges in determining optimal PEEP levels for ARDS patients.
- To discuss the balance between lung overstretching and derecruitment in PEEP setting.
Main Methods:
- Review and synthesis of recent studies on PEEP titration in ARDS.
- Discussion of physiological principles guiding PEEP selection.
Main Results:
- Optimal PEEP involves balancing regional overstretching and derecruitment.
- Higher PEEP may be needed early in ARDS, irrespective of oxygenation.
- The precise method for PEEP titration in ARDS remains undetermined.
Conclusions:
- Establishing optimal PEEP in ARDS is complex and requires careful consideration of competing physiological effects.
- Further research is needed to determine the most effective PEEP titration strategies for ARDS management.