PT  - JOURNAL ARTICLE
AU  - Karim Girgis
AU  - Hala Hamed
AU  - Yehia Khater
AU  - Robert M Kacmarek
TI  - A Decremental PEEP Trial Identifies the PEEP Level That Maintains Oxygenation After Lung Recruitment
DP  - 2006 Oct 01
TA  - Respiratory Care
PG  - 1132--1139
VI  - 51
IP  - 10
4099  - http://rc.rcjournal.com/content/51/10/1132.short
4100  - http://rc.rcjournal.com/content/51/10/1132.full
AB  - OBJECTIVE: To assess the ability of a decremental trial of positive end-expiratory pressure (PEEP) to identify an optimal PEEP level that maintains oxygenation after a lung-recruitment maneuver. DESIGN: Prospective clinical trial. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: Twenty sedated patients with acute lung injury and/or acute respiratory distress syndrome, ventilated for 1.2 ± 0.4 d. INTERVENTION: Each patient received up to 3 lung-recruitment maneuvers with continuous positive airway pressure of 40 cm H2O sustained for 40 s to increase the ratio of PaO2 to FIO2 by > 20%. Following the lung-recruitment maneuver, PEEP was set at 20 cm H2O and then the FIO2 was decreased until the oxygen saturation (measured via pulse oximetry [SpO2]) was 90–94%. PEEP was then decreased in 2-cm H2O steps until the SpO2 dropped below 90%. The step preceding the drop to below 90% was considered the optimal PEEP. The lung was then re-recruited and PEEP and FIO2 were set at the identified levels. The patients were followed for 4 h after the PEEP trial and the setting of PEEP and FIO2. RESULTS: After the lung-recruitment maneuver, all the patients' PaO2/FIO2 increased > 50%. The mean ± SD PaO2/FIO2 on the optimal decremental trial PEEP was 211 ± 79 mm Hg, versus 135 ± 37 mm Hg at baseline (p < 0.001), and was sustained at that level for the 4-h study period (227 ± 81 mm Hg at 4 h). FIO2 at baseline was 0.54 ± 0.12 versus 0.38 ± 0.12 (p < 0.001) at 4 h. PEEP was 11.9 ± 3.0 cm H2O at baseline and 9.1 ± 4.7 cm H2O (p = 0.011) at 4 h. CONCLUSION: A decremental PEEP trial identifies a PEEP setting that sustains for 4 h the oxygenation benefit of a 40-cm H2O, 40-s lung-recruitment maneuver.