BACKGROUND Trials have provided conflicting results regarding the effect of different ventilatory strategies on the outcomes of patients with the acute respiratory distress syndrome (ARDS) and acute lung injury. PURPOSE To determine whether ventilation with low tidal volume (Vt) and limited airway pressure or higher positive end-expiratory pressure (PEEP) improves outcomes for patients with A...

Dynamic hyperinflation (DH) is a consequence of severe airflow obstruction in patients with asthma and chronic obstructive pulmonary disease (COPD). Incorrect setting of positive end-expiratory pressure (PEEP) can lead either to unopposed intrinsic PEEP (iPEEP) (when set too low) or to an increase in lung volume if PEEP is set above iPEEP. DH and iPEEP can lead to haemodynamic compromise [1], i...

To the Editor:—The recent article by Thille et al. and the accompanying editorial by Rouby discuss the effects of positive end-expiratory pressure (PEEP) on pulmonary recruitability in patients with adult respiratory distress syndrome (ARDS). Thille et al. found that alveolar recruitment was similar in pulmonary and extrapulmonary ARDS and concluded that PEEP levels should not be determined bas...

BACKGROUND The optimal level of positive end-expiratory pressure (PEEP) is still widely debated in treating acute respiratory distress syndrome (ARDS) patients. Current methods of selecting PEEP only provide a range of values and do not provide unique patient-specific solutions. Model-based methods offer a novel way of using non-invasive pressure-volume (PV) measurements to estimate patient rec...

To the Editor:—The recent article by Thille et al. and the accompanying editorial by Rouby discuss the effects of positive end-expiratory pressure (PEEP) on pulmonary recruitability in patients with adult respiratory distress syndrome (ARDS). Thille et al. found that alveolar recruitment was similar in pulmonary and extrapulmonary ARDS and concluded that PEEP levels should not be determined bas...

Editor’s key points † The use of PEEP is beneficial in mechanically ventilated critically ill patients with acute lung injury. † PEEP may also be useful during surgery under general anaesthesia, but the optimum levels are uncertain. † In this small observational study, a PEEP setting of 5 cm H2O was insufficient to prevent derecruitment and a reduction in compliance. † Higher, individualized se...

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 ventilati...