CARING FOR THE CRITICALLY ILL PATIENT Positive End-Expiratory Pressure Setting in Adults With Acute Lung Injury and Acute Respiratory Distress Syndrome A Randomized Controlled Trial

POSITIVE END-EXPIRATORY PRESsure (PEEP) is an essential component of the management of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). PEEP improves hypoxemia and decreases intrapulmonary shunting, and these effects have been the basis for titrating PEEP in clinical practice. Numerous experimental studies showed that PEEP protected the lung in various models of ventilationinduced lung injury. Although the mechanisms of this protective effect are not fully elucidated, they may be mediated by PEEP-induced alveolar recruitment, which avoids cyclic airSee also pp 637, 691, and 693. Author Affiliations are listed at the end of this article. Corresponding Author: Alain Mercat, MD, Département de Réanimation Médicale et Médecine Hyperbare, CHU d’Angers, 4 Rue Larrey, 49933 Angers CEDEX 09, France ([email protected]). Context The need for lung protection is universally accepted, but the optimal level of positive end-expiratory pressure (PEEP) in patients with acute lung injury (ALI) or acute respiratory distress syndrome remains debated.