Can heterogeneity in ventilation be good?

Eduardo Lv Costa,Marcelo Bp Amato

doi:10.1186/cc8901

Abstract

Selection of the optimal positive end-expiratory pressure (PEEP) to avoid ventilator-induced lung injury in patients under mechanical ventilation is still a matter of debate. Many methods are available, but none is considered the gold standard. In the previous issue of Critical Care, Zhao and colleagues applied a method based on electrical impedance tomography to help select the PEEP that minimized ventilation inhomogeneities. Though promising when alveolar collapse and overdistension are present, this method might be misleading in patients with normal lungs.

Highlights

Selection of the optimal positive end-expiratory pressure (PEEP) to avoid ventilator-induced lung injury in patients under mechanical ventilation is still a matter of debate
In the previous issue of Critical Care, Zhao and colleagues [1] applied a method based on electrical impedance tomography (EIT) to help select the positive endexpiratory pressure (PEEP) that minimized ventilation inhomogeneities in healthy lungs
*Correspondence: amato@unisys.com.br 2Respiratory Intensive Care Unit, University of São Paulo School of Medicine, Av Dr Arnaldo, 455, Room 2206 (2nd floor), 01246-903, São Paulo, SP, Brazil Full list of author information is available at the end of the article

Summary

Introduction

Selection of the optimal positive end-expiratory pressure (PEEP) to avoid ventilator-induced lung injury in patients under mechanical ventilation is still a matter of debate. In the previous issue of Critical Care, Zhao and colleagues [1] applied a method based on electrical impedance tomography (EIT) to help select the positive endexpiratory pressure (PEEP) that minimized ventilation inhomogeneities in healthy lungs. Several methods, including those based on global mechanics [2,3], arterial blood gases [4], x-ray computerized tomography (CT) [5], and EIT [6,7], have been proposed to select the best PEEP in patients under mechanical ventilation.

Results

Conclusion