Lower Levels of Positive End-Expiratory Pressure Didn't Harm Patients Without Acute Respiratory Distress Syndrome

Low tidal volume ventilation, often with high levels of positive end-expiratory pressure (PEEP), is the standard of care for patients with acute respiratory distress syndrome (ARDS). Clinicians commonly adopt the same approach to support critically ill patients without ARDS. But could high levels of PEEP actually harm such patients?

Investigators from the Netherlands randomized 969 intubated patients (without ARDS, but assumed to require mechanical ventilation for at least 24 hours) to either high- or low-PEEP strategy. In the high-PEEP group, PEEP was maintained at 8 cm H₂O. In the low-PEEP group, initial PEEP was 5 cm H₂O, with titration down to 0 cm H₂O if oxygenation saturation remained ≥92% with fraction of inspired oxygen (FiO₂) no hig…