Selecting the 'right' positive end-expiratory pressure level

Luciano Gattinoni, Eleonora Carlesso, Massimo Cressoni

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose of Review: To compare the positive end-expiratory pressure selection aiming either to oxygenation or to the full lung opening. Recent Findings: Increasing positive end-expiratory pressure in patients with severe hypoxemia is associated with better outcome if the oxygenation response is greater and positive end-expiratory pressure tests may be performed in a few minutes. The oxygenation response to recruitment maneuvers was associated with better outcome in patients with acute respiratory distress syndrome from influenza A (H1N1). If, after recruitment maneuver, the recruitment is not sustained by sufficient positive end-expiratory pressure, the lung will unavoidably collapse. Several papers investigated the positive end-expiratory pressure selection according to the deflation limb of the pressure-volume curve. It is still questionable whether to consider oxygenation or respiratory mechanics change as the best marker for adequate selection. A growing interest is paid to the estimate of transpulmonary pressure, although no consensus is available on which methodology is preferable. Finally, the positive end-expiratory pressure adequate for full lung opening may be computed combining the computed tomography scan variables and the chest wall elastance. Summary: When compared, most of the methods give the same positive end-expiratory pressure values in patients with higher and lower recruitability. The positive end-expiratory pressure/inspiratory oxygen fraction tables are the only methods providing lower positive end-expiratory pressure in lower recruiters and higher positive end-expiratory pressure in higher recruiters.

Original languageEnglish
Pages (from-to)50-57
Number of pages8
JournalCurrent Opinion in Critical Care
Volume21
Issue number1
DOIs
Publication statusPublished - Feb 13 2015

Keywords

  • acute respiratory distress syndrome
  • computed tomography scan
  • esophageal pressure
  • oxygenation
  • positive end-expiratory pressure

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

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