Higher vs Lower Positive End-Expiratory Pressure in Patients With Acute Lung Injury and Acute Respiratory Distress Syndrome
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Open Access
- 3 March 2010
- journal article
- research article
- Published by American Medical Association (AMA) in JAMA
- Vol. 303 (9) , 865-873
- https://doi.org/10.1001/jama.2010.218
Abstract
Protecting lungs from ventilation-induced injury is an important principle in the management of patients with acute lung injury or acute respiratory distress syndrome (ARDS). Although the critical care community has generally endorsed lower tidal volumes and inspiratory pressures, the optimal level of positive end-expiratory pressure (PEEP) remains unestablished.1,2 Experimental data suggest that PEEP levels exceeding traditional values of 5 to 12 cm H2O can minimize cyclical alveolar collapse and corresponding shearing injury to the lungs in patients with considerable edema and alveolar collapse.3-5 For patients with relatively mild acute lung injury, however, potential adverse consequences of higher PEEP levels, including circulatory depression6 or lung overdistension,7 may outweigh the benefits. Several multicenter, randomized trials testing the incremental effect of higher levels of PEEP were confounded by baseline imbalances in prognostic factors and underpowered to rule in or rule out an important survival effect.8-10Keywords
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