Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome.

@article{Brower2004HigherVL,
  title={Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome.},
  author={Roy G. Brower and Paul N. Lanken and Neil R. MacIntyre and Michael A. Matthay and Alan H. Morris and Marek Ancukiewicz and David Alan Schoenfeld and Boyd Taylor Thompson},
  journal={The New England journal of medicine},
  year={2004},
  volume={351 4},
  pages={
          327-36
        }
}
BACKGROUND Most patients requiring mechanical ventilation for acute lung injury and the acute respiratory distress syndrome (ARDS) receive positive end-expiratory pressure (PEEP) of 5 to 12 cm of water. [] Key MethodMETHODS We randomly assigned 549 patients with acute lung injury and ARDS to receive mechanical ventilation with either lower or higher PEEP levels, which were set according to different tables of predetermined combinations of PEEP and fraction of inspired oxygen.
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Effects of high versus low positive end-expiratory pressures in acute respiratory distress syndrome.
TLDR
The protocol proposed by the Acute Respiratory Distress Syndrome Network, lacking solid physiologic basis, frequently fails to induceAlveolar recruitment and may increase the risk of alveolar overinflation.
Review: Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome
TLDR
Patients with ALI or ARDS who receive mechanical ventilation to a tidal volume goal of 6 ml per kilogram of predicted body weight obtain no clinically significant outcome benefit whether lower or higher PEEP levels are used.
Ventilation strategies for acute lung injury and acute respiratory distress syndrome.
TLDR
Two smaller trials showed that higher PEEP levels, comparable with the Express trial (14-16 cm H2O), can reduce mortality in ARDS, despite using plateau pressures that have been considered unsafe.
Ventilation strategies for acute lung injury and acute respiratory distress syndrome.
TLDR
Two smaller trials showed that higher PEEP levels, comparable with the Express trial (14-16 cm H2O), can reduce mortality in ARDS, despite using plateau pressures that have been considered unsafe.
Ventilation strategies for acute lung injury and acute respiratory distress syndrome.
TLDR
Two smaller trials showed that higher PEEP levels, comparable with the Express trial (14-16 cm H2O), can reduce mortality in ARDS, despite using plateau pressures that have been considered unsafe.
Ventilation Strategies for Acute Lung Injury and Acute Respiratory Distress Syndrome
TLDR
Two smaller trials showed that higher PEEP levels, comparable with the Express trial (14-16 cm H2O), can reduce mortality in ARDS, despite using plateau pressures that have been considered unsafe.
High or conventional positive end-expiratory pressure in acute respiratory distress syndrome
HighervsLowerPositiveEnd-ExpiratoryPressure in Patients With Acute Lung Injury and Acute Respiratory Distress Syndrome Systematic Review and Meta-analysis
TLDR
Experimental data suggest that PEEP levels exceeding traditional values of 5 to 12 cm H2O can minimize cyclical alveolar collapse and corresponding shearing injury to the lungs in patients with considerable edema and alveolars collapse.
Does the use of high PEEP levels prevent ventilator-induced lung injury?
TLDR
The benefits and limitations of the open lung approach are discussed, some recent experimental and clinical trials on the use of high versus low/moderate positive end-expiratory pressure levels are discussed and dynamic (tidal volume) from static strain is distinguished and their roles in inducing ventilator-induced lung injury are discussed.
Mechanical ventilation guided by esophageal pressure in acute lung injury.
TLDR
A ventilator strategy using esophageal pressures to estimate the transpulmonary pressure significantly improves oxygenation and compliance and Multicenter clinical trials are needed to determine whether this approach should be widely adopted.
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References

SHOWING 1-10 OF 43 REFERENCES
Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure*
TLDR
In ALI/ARDS patients receiving mechanical ventilation with low tidal volumes and high PEEP, short-term effects of RMs as conducted in this study are variable and Beneficial effects on gas exchange in responders appear to be of brief duration.
Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.
TLDR
As compared with conventional ventilation, the protective strategy was associated with improved survival at 28 days, a higher rate of weaning from mechanical ventilation, and a lower rate of barotrauma in patients with the acute respiratory distress syndrome.
Titration of tidal volume and induced hypercapnia in acute respiratory distress syndrome.
Mechanical ventilation may promote overdistension-induced pulmonary lesions in patients with acute respiratory distress syndrome (ARDS). The static pressure-volume (P-V) curve of the respiratory…
Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS.
TLDR
It is concluded that no benefit could be observed with reduced VT titrated to reach plateau pressures around 25 cm H2O compared with a more conventional approach in which normocapnia was achieved with plateau pressures already below 35 cm H 2O.
Clinicians' approaches to mechanical ventilation in acute lung injury and ARDS.
TLDR
Physicians in ARDS Network centers caring for patients early in the course of ALI/ARDS used volume-targeted ventilation and selected tidal volumes that resulted in Pplats generally < 35 cm H(2)O.
Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial.
TLDR
Mechanical ventilation can induce a cytokine response that may be attenuated by a strategy to minimize overdistention and recruitment/derecruitment of the lung and whether these physiological improvements are associated with improvements in clinical end points should be determined.
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.
TLDR
In patients with acute lung injury and the acute respiratory distress syndrome, mechanical ventilation with a lower tidal volume than is traditionally used results in decreased mortality and increases the number of days without ventilator use.
Lung-protective ventilation strategies in acute lung injury
TLDR
Evidence supports the use of a volume- and pressure-limited approach to mechanical ventilation in patients with acute lung injury and it is not yet clear whether the open-lung approach will further reduce mortality in patients receiving volume-and-pressure-limited ventilation support.
Tidal ventilation at low airway pressures can augment lung injury.
TLDR
End-expiratory lung volume is an important determinant of the degree and site of lung injury during positive-pressure ventilation as ventilation occurs from below to above the infection point (Pinf) as determined from the inspiratory pressure-volume curve.
Adverse effects of large tidal volume and low PEEP in canine acid aspiration.
TLDR
It is concluded that small VT-high PEEP is a better mode of ventilating acute lung injury than large VT-low PEEP because edema accumulation is less and venous admixture is less.
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