Moderate vs. High PEEP for ARDS Patients

Increasing positive end-expiratory pressure levels while avoiding excessive hyperinflation lowers morbidity but not mortality rates in patients with acute lung injury and acute respiratory distress syndrome.

Positive end-expiratory pressure (PEEP) is an essential part of managing patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). PEEP-related alveolar recruitment works largely by preventing cyclic airway collapse and reopening. However, high PEEP levels can cause hyperinflation and can lead to ventilator-induced lung injury.

To determine the optimal level of PEEP, researchers conducted the randomized controlled Expiratory Pressure (Express) trial; 767 adults (mean age, 60) who met criteria for ALI or ARDS were recruited from 37 intensive care units in France. Patients who were assigned to the minimal-distention group (controls) received moderate PEEP therapy (5–9 cm H₂O), whereas patients in the increased-recru…

Reviewing Author

Neil Winawer, MD

Disclosures

Nothing to disclose

Neil Winawer, MD

Disclosures

Nothing to disclose