Abstract
The injurious effects of alveolar overdistention are well accepted, and there is little debate regarding the importance of pressure and volume limitation during mechanical ventilation. The role of recruitment maneuvers is more controversial. Alveolar recruitment is desirable if it can be achieved, but the potential for recruitment is variable among patients with ARDS. A stepwise recruitment maneuver, similar to an incremental PEEP titration, is favored over sustained inflation recruitment maneuvers. Many approaches to PEEP titration have been proposed, and the best method to choose the most appropriate level for an individual patient is unclear. A PEEP level should be selected that balances alveolar recruitment against overdistention. The easiest approach to select PEEP might be according to the severity of the disease: 5–10 cm H2O PEEP in mild ARDS, 10–15 cm H2O PEEP in moderate ARDS, and 15–20 cm H2O PEEP in severe ARDS. Recruitment maneuvers and PEEP should be used within the context of lung protection and not just as a means of improving oxygenation.
Footnotes
- Correspondence: Dean R Hess PhD RRT FAARC, Respiratory Care Services, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail: dhess{at}mgh.harvard.edu
Dr Hess has disclosed relationships with Philips Respironics, Bayer, McGraw-Hill, Jones and Bartlett, UpToDate, and the American Board of Internal Medicine.
Dr Hess presented a version of this paper at the 30th New Horizons Symposium at the AARC Congress 2014, held December 10, 2014, in Las Vegas, Nevada.
- Copyright © 2015 by Daedalus Enterprises
