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Does high PEEP prevent alveolar cycling?
M Cressoni1, C Chiurazzi2, D Chiumello3,4
1Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via Di Rudinì 8, 20100, Milano, Italy. mcressoni@hotmail.com.
Medizinische Klinik, Intensivmedizin Und Notfallmedizin
|November 15, 2017
Summary
Positive end-expiratory pressure (PEEP) in mechanical ventilation for acute respiratory distress syndrome (ARDS) may not improve survival. Higher PEEP levels are insufficient to keep lungs open, potentially worsening lung inhomogeneity.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Respiratory Physiology
Background:
- Mechanical ventilation is crucial for acute respiratory distress syndrome (ARDS) patients.
- Preclinical data suggest high PEEP levels are protective, while clinical trials show no survival benefit.
Purpose of the Study:
- To investigate the behavior of ARDS lungs during mechanical ventilation using CT scanning.
- To reconcile conflicting findings between animal studies and clinical trials regarding PEEP strategies.
Main Methods:
- Utilized CT scanning to observe ARDS lung mechanics during inflation and deflation.
- Analyzed lung behavior under varying positive end-expiratory pressure (PEEP) levels.
Main Results:
- A PEEP of 15 cmH2O is insufficient to maintain lung opening throughout the respiratory cycle.
- Lung recruitment occurs continuously, and higher PEEP shifts lung opening/closing regions without eliminating them.
- Increasing PEEP has minimal effect on reducing lung inhomogeneity in recruited tissues.
Conclusions:
- Current PEEP strategies in ARDS may be suboptimal due to insufficient lung recruitment and persistent inhomogeneity.
- Further research is needed to optimize PEEP settings for improved ARDS patient outcomes.
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