Is Esophageal Balloon-Guided PEEP Titration Worthwhile?

Patients with acute respiratory distress syndrome (ARDS) respond variably to positive end-expiratory pressure (PEEP), and we have no established way to find the “right” PEEP for an individual patient. More than a decade ago, a single-center study demonstrated improved oxygenation and lung compliance when PEEP was set through use of an esophageal balloon (NEJM JW Emerg Med Dec 2008 and N Engl J Med 2008; 359:2095). Because esophageal pressure estimates pleural pressure, this technique potentially helps avoid over- and underdistention of alveoli and mitigates lung injury.

Investigators randomized 202 patients with moderate-to-severe ARDS (partial pressure of arterial oxygen:fraction of inspired oxygen [PaO₂:FiO.₂] <200) from 14 North American …