Positive end-expiratory pressure in acute respiratory distress syndrome: should the 'open lung strategy' be replaced by a 'protective lung strategy'?

doi:10.1186/cc6183

Critical Care
Volume 11
Issue 6

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Commentary

Positive end-expiratory pressure in acute respiratory distress syndrome: should the 'open lung strategy' be replaced by a 'protective lung strategy'?

Jean-Jacques Rouby¹ , Fabio Ferrari², Bélaïd Bouhemad³ and Qin Lu⁴

¹Professor of Anaesthesia and Critical Care, Head of Surgical Intensive Care Unit, Réanimation Chirurgicale Polyvalente Pierre Viars, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris – 6, 47/83 boulevard de l'Hôpital, 75651 Paris Cédex 13, France

²Research Fellow, Department of Anesthesiology, Faculdade de Medicina da Universidade Estadual Paulista Julio de Mesquita Filho, Botucatu, Brazil

³Praticien Hospitalier, Surgical Intensive Care Unit, Réanimation Chirurgicale Polyvalente Pierre Viars, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris – 6, 47/83 boulevard de l'Hôpital, 75651 Paris Cédex 13, France

⁴Praticien Hospitalier, Surgical Intensive Care Unit, Director of Research, Réanimation Chirurgicale Polyvalente Pierre Viars, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris – 6, 47/83 boulevard de l'Hôpital, 75651 Paris Cédex 13, France

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Critical Care 2007, 11:180doi:10.1186/cc6183


Published:	11 December 2007

See related research by Carvalho et al., http://ccforum.com/content/11/4/R86 and see related letter by Markhorst et al., http://ccforum.com/content/12/1/408

Abstract

In patients with acute respiratory distress syndrome, positive end-expiratory pressure is associated with alveolar recruitment and lung hyperinflation despite the administration of a low tidal volume. The best positive end-expiratory pressure should correspond to the best compromise between recruitment and distension, a condition that coincides with the best respiratory elastance.