Higher PEEP Improves Survival in ARDS Patients

Meta-analysis reveals that patients with severe acute respiratory distress syndrome are most likely to benefit from higher positive end-expiratory pressure.

Acute respiratory distress syndrome (ARDS) can lead to severe hypoxemia and considerable mortality, secondary to multiorgan dysfunction. A well-accepted protocol to attenuate ARDS-related mortality is to employ lung protection strategies that focus on low tidal volumes and plateau pressures. Data also suggest that higher levels (>5–12 cm H₂O) of positive end-expiratory pressure (PEEP) lower morbidity in ARDS patients by preventing the cyclic collapse and reopening of alveoli, which leads to “atelec trauma” that further stimulates the inflammatory cascade and worsens alveolar edema. The potential benefit of higher PEEP must be weighed against its potential adverse consequences, such as circulatory depression and barotrauma.

Prior trials in wh…

Reviewing Author

Aaron J. Calderon, MD, FACP

Disclosures

EquityAbbott; Medtronic; Merck; Pfizer; CVS Health Corp.; Bristol Myers Squibb

Aaron J. Calderon, MD, FACP

Disclosures

EquityAbbott; Medtronic; Merck; Pfizer; CVS Health Corp.; Bristol Myers Squibb