PEEP Setting Strategy

How it works

Risks & contraindications

Comparisons

Evidence quality

Highlighted claims

• Conventional PEEP setting often relies on oxygenation, but oxygenation is not a reliable indicator of recruitment. — Careful ventilation in acute respiratory distress syndrome: the protocol of the CAVIARDS international multicentre randomised basket trial
• PEEP can be beneficial by preventing atelectrauma and promoting recruitment, but harmful in non-recruitable lungs by promoting overdistension and haemodynamic compromise. — Careful ventilation in acute respiratory distress syndrome: the protocol of the CAVIARDS international multicentre randomised basket trial
• When airway closure is present, measured plateau and driving pressures reflect pressure in closed airways rather than alveolar pressure, impairing their interpretation. — Careful ventilation in acute respiratory distress syndrome: the protocol of the CAVIARDS international multicentre randomised basket trial
• The EXPRESS trial was the only trial comparing PEEP strategies with potentially positive results; it used mechanics-based PEEP titration rather than oxygenation alone and showed benefit on duration of ventilation. — Careful ventilation in acute respiratory distress syndrome: the protocol of the CAVIARDS international multicentre randomised basket trial
• Complete airway closure above 5 cm H2O is present in 30% to 40% of ARDS patients. — Careful ventilation in acute respiratory distress syndrome: the protocol of the CAVIARDS international multicentre randomised basket trial
• Prior randomised trials comparing PEEP levels failed to identify which patients had recruitable lungs, which may explain why high-PEEP benefit could not be separated from harm. — Careful ventilation in acute respiratory distress syndrome: the protocol of the CAVIARDS international multicentre randomised basket trial