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Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome
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Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome
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Journal Article
Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome
2004
Overview
More than 35 years have passed since it was discovered that the application of positive end-expiratory pressure (PEEP) improved arterial oxygenation in patients with certain forms of respiratory failure who were treated with mechanical ventilation. In this study, investigators from an NIH-sponsored consortium compared the effects of higher and lower levels of PEEP on survival after the institution of mechanical ventilation. The trial was terminated early after neither approach proved to have an advantage.
This study compared the effects of higher and lower levels of PEEP on survival.
Mechanical ventilation is critical for the survival of most patients with acute lung injury and the acute respiratory distress syndrome (ARDS). However, some approaches to mechanical ventilation may cause additional lung injury,
1
,
2
which could delay or prevent resolution of respiratory failure. Ventilator-induced lung injury may be caused by overdistention of aerated lung regions, especially when large tidal volumes are used.
3
–
5
Ventilator-induced lung injury may also occur if a substantial portion of the lung is not aerated at end-expiration because of atelectasis, flooding, and consolidation. This may cause excessive mechanical forces in aerated lung regions,
6
between aerated and nonaerated . . .
Publisher
Massachusetts Medical Society
Subject
/ Aged
/ Biological and medical sciences
/ Female
/ Humans
/ Injuries
/ Intercellular Adhesion Molecule-1 - blood
/ Lungs
/ Male
/ Positive-Pressure Respiration - methods
/ Proteins
/ Pulmonary Surfactant-Associated Protein D - blood
/ Respiratory distress syndrome
/ Respiratory Distress Syndrome, Adult - blood
/ Respiratory Distress Syndrome, Adult - mortality
/ Respiratory Distress Syndrome, Adult - physiopathology
/ Respiratory Distress Syndrome, Adult - therapy
/ Respiratory Physiological Phenomena
