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Commentary

Recruit the lung before titrating the right positive end-expiratory pressure to protect it

Fernando Suarez-Sipmann1* and Stephan H Bohm2

Author Affiliations

1 Department of Intensive Care Medicine, Fundación Jiménez Díaz-UTE, Avda de los Reyes Católicos 2, 28040 Madrid, Spain

2 Research Centre for Nanomedicine, CSEM Centre Suisse d'Electronique et de Microtechnique SA, Schulstrasse 1, 7302 Landquart, Switzerland

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Critical Care 2009, 13:134  doi:10.1186/cc7763


See related research by Huh et al., http://ccforum.com/content/13/1/R22

Published: 6 May 2009

Abstract

The optimal level of positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome patients is still controversial and has gained renewed interest in the era of 'lung protective ventilation strategies'. Despite experimental evidence that higher levels of PEEP protect against ventilator-induced lung injury, recent clinical trials have failed to demonstrate clear survival benefits. The open-lung protective ventilation strategy combines lung recruitment maneuvers with a decremental PEEP trial aimed at finding the minimum level of PEEP that prevents the lung from collapsing. This approach to PEEP titration is more likely to exert its protective effects and is clearly different from the one used in previous clinical trials.