Clinical Year in Review III:: Mechanical Ventilation, Acute Respiratory Distress Syndrome, Nonpulmonary Intensive Care Unit, and Quality Performance Assessment Metrics in Your Practice

Abstract

18.6%; RR, 0.64; 95% CI, 0.54‐0.75; P , 0.001), and moreover, the rate of death after rescue therapies was significantly lower (7.5 vs. 11.3%; RR, 0.65; 95% CI, 0.52‐0.80; P , 0.001) (3). In patients with ARDS, there was an insignificant increase in risk of pneumothorax with higher PEEP (RR, 1.23; 95% CI, 0.94‐1.68; P ¼ 0.13), and no difference in fatal consequences from barotrauma (RR, 1.2; 95% CI, 0.79‐1.81; P ¼ 0.39) (3). The use of neuromuscular blockers, corticosteroids, and vasopressors was similar between groups treated with higher and lower PEEP. In summary, this analysis suggests that higher PEEP is safe in patients with ARDS and may reduce the need for performing rescue therapies. Further, low to moderate levels of PEEP should be used for most patients with ALI.