UMEM Educational Pearls

Category: Critical Care

Title: PEEP in Acute Lung Injury

Keywords: PEEP, acute lung injury, acute respiratory distress syndrome (PubMed Search)

Posted: 5/13/2008 by Mike Winters, MD (Updated: 12/11/2023)
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Acute Lung Injury (ALI) / Acute Respiratory Distress Syndrome (ARDS)

ALI and ARDS are defined as:
- bilateral pulmonary infiltrates on CXR
- pulmonary capillary wedge pressure < 18 mm Hg (no heart failure)
- P_aO₂ / F_iO₂< 300 = ALI
- P_aO₂/ F_iO₂ < 200 = ARDS
The current management for patients with ALI or ARDS is low tidal volume ventilation and a conservative fluid management strategy
Two recent trials (EXPRESS and LOVS) evaluated different applications of PEEP in patients with ALI/ARDS
Both studies evaluated lower levels of PEEP (5-10) vs. higher levels of PEEP titrated to plateau pressure
Bottom line: different PEEP strategies did not influence survival, although higher levels did result in improved oxygenation.