Bedside Selection of Positive End-Expiratory Pressure in Mild, Moderate, and Severe Acute Respiratory Distress Syndrome*

• DOI: 10.1097/ccm.0b013e3182a6384f
• Publication Date: 2013-11-06T14:05:13Z
• Authors: Davide Chiumello; Massimo Cressoni; Eleonora Carlesso; Maria L. Caspani; Antonella Marino; Elisabetta Gallazzi; Pietro Caironi; Marco Lazzerini; Onnen Moerer; Michael Quintel; Luciano Gattinoni
• Keywords: Positive End-Expiratory Pressure

Positive end-expiratory pressure exerts its effects keeping open at end-expiration previously collapsed areas of the lung; consequently, higher positive should be limited to patients with high recruitability. We aimed determine which bedside method would provide better related lung recruitability.Prospective study performed between 2008 and 2011.Two university hospitals (Italy Germany).Fifty-one acute respiratory distress syndrome.Whole CT scans were taken in static conditions 5 45 cm H2O during an end-expiratory/end-inspiratory pause measure To select individual pressure, we applied methods based on mechanics (ExPress, stress index), esophageal oxygenation (higher table ventilation study).Patients classified mild, moderate severe syndrome. levels selected by ExPress, index, absolute pressures unrelated recruitability, whereas showed a weak relationship recruitability (r = 0.29; p < 0.0001). When according syndrome Berlin definition, was only one gave lower mild compared (8 ± 2 11 3 vs 15 H2O; 0.05), similar values moderate, The different each other exception two (ExPress index).Bedside selection or syndrome, oxygenation-based provided progressively increasing from