Today's NEJM's cover article is by Gattinoni et al and they have looked at the ammount of "recruitable" lung in the setting of ARDS. This is after the results from the ALVEOLI study on High-Low PEEP.
How do you use PEEP in your ARDS patients? Have you been trying to "recruit" more lung with higher PEEP? Since the patients on the High PEEP did not have worse outcomes are you more comfortable with higher PEEP when oxygenation is a problem?
3 comments - CLICK HERE to read & add your own!:
I don't have a magic number with the PEEP, but as long as plateau pressures are less than 35, I'm comfortable with PEEP settings in the high teens.
Using a best PEEP curve is also occassionally useful. Swan's are rarely used nowadays, so we look at MAP from an a-line or other similar paramters when determining best PEEPs in these people.
I use very short expiration time such as 0.6-0.8 sec with APRV to prevent cyclic closure of alveoli. You can keep plateau pressure and FiO2 lower than other modes of ventilation.
i attempt to recruit a patient and leave them at high peep(>15). if they do not improve with the recruitment maneuver, i may back off the peep, and if they respond, i may increase the peep or switch to aprv ....I am playing around with the pv curve to determine the lower inflection point as well, but haven't had too much luck with that yet.
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