What are the benefits to higher positive end-expiratory pressure (PEEP) for the treatment of acute respiratory distress syndrome (ARDS)?

Updated: Mar 27, 2020
  • Author: Eloise M Harman, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

A 2010 review by Briel et al found that treatment with higher of PEEP demonstrated no advantage over treatment with lower levels in patients with ALI or ARDS; however, among patients with ARDS, higher levels were associated with improved survival. [43]

A study by Bellani et al found that in patients with ALI managed with relatively high PEEP, metabolic activity of aerated regions was associated with plateau pressure and regional tidal volume that was normalized by end-expiratory lung gas volume; no association was found between cyclic recruitment/derecruitment and increased metabolic activity. [44]


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