Positive end-expiratory pressure in acute respiratory distress syndrome – an old yet mysterious tool

Enrico Calzia,Peter Radermacher

doi:10.1186/cc2914

Abstract

A recent study by Bruhn and colleagues, discussed here, confirms that even high levels of positive end-expiratory pressure (PEEP) – up to 20 cmH2O – may be applied in conditions of moderate acute respiratory distress syndrome. Such levels of PEEP were found to be safe in terms of their impact on cardiac output and adequacy of gastric mucosal perfusion once systemic haemodynamics were stabilized by adequate fluid replacement and catecholamine therapy. However, we strongly recommend that the reader does not oversimplify the conclusions of that study. PEEP therapy is not inherently safe with respect to haemodynamics and regional organ perfusion, but it may be used safely, even at high levels of up to 20 cmH2O, if haemodynamic therapy is appropriate.

Highlights

The introduction of positive end-expiratory pressure (PEEP) into the practice of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) [1] was among the most important milestones in critical care therapy
In this issue of Critical Care, Bruhn and colleagues [8] report the effects of PEEP on adequacy of gastric mucosal perfusion in ARDS patients
One should not conclude that PEEP up to 20 cmH2O is generally safe in patients with ARDS in terms of haemodynamics or even regional organ perfusion

Summary

Introduction

The introduction of positive end-expiratory pressure (PEEP) into the practice of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) [1] was among the most important milestones in critical care therapy. Acute respiratory distress syndrome, mechanical ventilation, PCO2 gap, positive endexpiratory pressure, regional organ perfusion Current strategies of mechanical ventilation for patients with acute lung injury or ARDS [7] increasingly recommend fairly high levels of PEEP.

Results

Conclusion