Finding the Optimal PEEP for Patients with ARDS

The exact amount of positive end-expiratory pressure (PEEP) that will prevent alveolar collapse while avoiding overdistension in patients with acute lung injury or acute respiratory distress syndrome (ARDS) is unknown, largely because pleural pressure, a component of transpulmonary pressure (airway pressure minus pleural pressure), is difficult to measure in the patient care setting. Noting a correlation, albeit imperfect, between esophageal pressure and pleural pressure, investigators assessed the efficacy of using esophageal pressure (measured by a balloon catheter inserted into the esophagus) to guide the level of PEEP. In a controlled trial, 61 severely ill (mean APACHE score, 26.6) intensive care unit (ICU) patients with acute lung inj…