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Recruit the lung before titrating the right positive end-expiratory pressure to protect it

By Fernando Suarez-Sipmann and Stephan H Bohm


The optimal level of positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome patients is still controversial and has gained renewed interest in the era of 'lung protective ventilation strategies'. Despite experimental evidence that higher levels of PEEP protect against ventilator-induced lung injury, recent clinical trials have failed to demonstrate clear survival benefits. The open-lung protective ventilation strategy combines lung recruitment maneuvers with a decremental PEEP trial aimed at finding the minimum level of PEEP that prevents the lung from collapsing. This approach to PEEP titration is more likely to exert its protective effects and is clearly different from the one used in previous clinical trials

Topics: Commentary
Publisher: BioMed Central
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Provided by: PubMed Central

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  1. (2004). Alveolar recruitment in combination with sufficient positive end-expiratory pressure increases oxygenation and lung aeration in patients with severe chest trauma. Crit Care Med
  2. (2006). Amato MB: Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome. Am J Respir Crit Care Med
  3. (2001). Best compliance during a decremental, but not incremental, positive end-expiratory pressure trial is related to open-lung positive end-expiratory pressure: a mathematical model of acute respiratory distress syndrome lungs. Am J Respir Crit Care Med
  4. (1998). Carvalho CR: Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.
  5. (2009). Efficacy of positive end-expiratory pressure titration after the alveolar recruitment manoeuver in patients with acute respiratory distress syndrome. Crit Care
  6. (1995). F: Effects of positive endexpiratory pressure on regional distribution of tidal volume and recruitment in adult respiratory distress syndrome. Am J Respir Crit Care Med
  7. (2007). Hedenstierna G: Use of dynamic compliance for open lung positive end-expiratory pressure titration in an experimental study. Crit Care Med
  8. (2002). MV: Effects of recruiting maneuvers in patients with acute respiratory distress syndrome ventilated with protective ventilatory strategy. Anesthesiology
  9. (2008). ND: Recruitment maneuvers for acute lung injury: a systematic review. Am J Respir Crit Care Med
  10. (1992). Open up the lung and keep the lung open. Intensive Care Med
  11. (2003). Recruitment manoeuvres in acute lung injury/acute respiratory distress syndrome. Eur Respir J Suppl
  12. (2000). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network.
  13. (2001). WD: Mechanistic scheme and effect of ‘extended sigh’ as a recruitment maneuver in patients with acute respiratory distress syndrome: a preliminary study. Crit Care Med

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