NDLI: Positive end-expiratory pressure.

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Positive end-expiratory pressure.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Gattinoni, Luciano Carlesso, Eleonora Brazzi, Luca Caironi, Pietro
Description	Country affiliation: Italy Author Affiliation: Gattinoni L ( Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS-Ospedale Maggiore Policlinico Mangiagalli Regina Elena di Milano, Milan, Italy. gattinon@policlinico.mi.it)
Abstract	PURPOSE OF REVIEW: In the last 2 years, several reports have dealt with recruitment/positive end-expiratory pressure (PEEP) selection. Most of them confirm previous results and few add new information. RECENT FINDINGS: It has been definitely confirmed that opening pressures are different throughout the acute respiratory distress syndrome lung parenchyma, ranging from 5-10 up to 30-40 cmH2O. The highest opening pressures are required to open the most dependent lung regions. It has been found that in 2 s, most of the recruitable lung regions may be open when a proper pressure is applied. The best way to assess recruitment is computed tomography scanning, whereas lung mechanics are a reasonable bedside surrogate. Impedance tomography has been increasingly tested, whereas gas exchange is the less reliable indicator of recruitment. A large outcome study showed that higher PEEP might provide survival benefit in a subgroup of more severe patients as compared with lower PEEP. To set PEEP in each individual patient, the use of the expiratory limb of the pressure-volume curve has been suggested. Setting PEEP according to transpulmonary pressure has a robust physiological background, although it requires confirmatory study. SUMMARY: Indiscriminate application of recruitment maneuver in unselected acute respiratory distress syndrome population does not provide benefits. However, in the most severe patients, recruitment maneuver has to be considered and higher PEEP applied. To individualize PEEP, the expiratory phase has to be considered, and the esophageal pressure measurement to compute the transpulmonary pressure should be progressively introduced in clinical practice.
File Format	HTM / HTML
ISSN	10705295
Issue Number	1
Journal	Current Opinion in Critical Care
Volume Number	16
e-ISSN	15317072
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2010-02-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Critical Care Positive-pressure Respiration Methods Humans Tomography, X-ray Computed Journal Article Review
Content Type	Text
Resource Type	Article
Subject	Critical Care and Intensive Care Medicine

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