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Curr Opin Crit Care. 2015 Feb;21(1):50-7. doi: 10.1097/MCC.0000000000000166.

Selecting the 'right' positive end-expiratory pressure level.

Author information

1
aDipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS CĂ  Granda Ospedale Maggiore Policlinico bDipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, UniversitĂ  degli Studi di Milano, Milan, Italy.

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.

PMID:
25546534
DOI:
10.1097/MCC.0000000000000166
[Indexed for MEDLINE]

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