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: 10/21/2021)
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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)
    • PaO2 / FiO2 < 300 = ALI
    • PaO2 / FiO2 < 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.