Positive end-expiratory pressure (PEEP) is a crucial element of ventilatory treatment for ARDS patients. PEEP increases end-expiratory lung volume (EELV), and may avoid derecruitment, but also cause alveolar overdistension, increased right afterload and dead space. Higher rather than lower levels of PEEP are suggested in moderate or severe ARDS in the latest guidelines. The strategies available for PEEP setting in ARDS include: PEEP/FiO2 combination tables, CO2 clearance, respiratory mechanichs (e.g. driving pressure, stress index) the measurement of transpulmonary pressure and lung imaging. The pathophysiological rationale and main clinical outcomes of the varius strategies are discussed.
Rezoagli, E., Bellani, G. (2022). PEEP Setting in ARDS. In G. Bellani (a cura di), Mechanical Ventilation from Pathophysiology to Clinical Evidence (pp. 187-197). Springer International Publishing [10.1007/978-3-030-93401-9_17].
PEEP Setting in ARDS
Rezoagli E.Primo
;Bellani G.
2022
Abstract
Positive end-expiratory pressure (PEEP) is a crucial element of ventilatory treatment for ARDS patients. PEEP increases end-expiratory lung volume (EELV), and may avoid derecruitment, but also cause alveolar overdistension, increased right afterload and dead space. Higher rather than lower levels of PEEP are suggested in moderate or severe ARDS in the latest guidelines. The strategies available for PEEP setting in ARDS include: PEEP/FiO2 combination tables, CO2 clearance, respiratory mechanichs (e.g. driving pressure, stress index) the measurement of transpulmonary pressure and lung imaging. The pathophysiological rationale and main clinical outcomes of the varius strategies are discussed.
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