Determing the optimal PEEP setting in patients with ARDS Kentaro OKAMOTO 1 1Department of Emergency and Critical Care Medicine, St. Marianna University Hospital pp.508-517
Published Date 2018/7/1
DOI https://doi.org/10.11477/mf.3102200531
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A substantial number of studies have been performed to determine optimal settings for positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS), but the best method to determine the optimal PEEP setting is still unknown. A realistic way to do this may be to determine the optimal PEEP setting using the lower PEEP/FIO2 table with concomitant use of the low tidal volume strategy in the ARDSnet protocol. Target goals include an inspiratory plateau pressure below 30cmH2O and a driving pressure below 15cmH2O, while an evaluation for alveolar recruitment is performed. When higher PEEP, as in the higher PEEP/FIO2 table, is needed, monitoring transpulmonary pressure should be considered if available. In addition, we should bear in mind both the benefits and harms of PEEP. The best PEEP setting for the lung in a patient with ARDS is not always best for the patient with ARDS.

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