Setting and Titrating Positive End-Expiratory Pressure.

Humans Lung Positive-Pressure Respiration Respiratory Distress Syndrome Respiratory Physiological Phenomena Ventilators, Mechanical
ARDS critical care mechanical ventilation

Journal

Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335

Informations de publication

Date de publication:
06 2022
Historique:
received: 02 11 2021
revised: 12 01 2022
accepted: 28 01 2022
pubmed: 9 2 2022
medline: 14 6 2022
entrez: 8 2 2022
Statut: ppublish

Résumé

Although maintaining some amount of positive end-expiratory pressure (PEEP) seems essential, selecting and titrating a specific level for patients with ARDS remains challenging despite extensive research on the subject. Although an "open lung" approach to ventilation is popular and has some degree of biological plausibility, it is not without risk. Furthermore, there is no clear evidence-based guidance regarding initial PEEP settings or how to titrate them early in the course of the illness. Many busy clinicians use a "one-size-fits-all" approach based on local medical culture, but an individualized approach has the potential to offer significant benefit. Here we present a pragmatic approach based on simple measurements available on all ventilators, focused on achieving balance between the potential risks and benefits of PEEP. Acknowledging "best PEEP" as an impossible goal, we aim for a straightforward method to achieve "better PEEP."

Identifiants

DOI: 10.1016/j.chest.2022.01.052 PMID: 35131298
pubmed: 35131298
pii: S0012-3692(22)00220-3
doi: 10.1016/j.chest.2022.01.052
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1566-1575

Informations de copyright

Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Auteurs

Scott J Millington (SJ)

University of Ottawa/The Ottawa Hospital, Ottawa, ON, Canada. Electronic address: smillington@toh.ca.

Pierre Cardinal (P)

University of Ottawa/The Ottawa Hospital, Ottawa, ON, Canada.

Laurent Brochard (L)

Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Setting and Titrating Positive End-Expiratory Pressure.
questionsmedicales.fr › Appareil respiratoire › Poumon › Setting and Titrating Positive End-Expiratory Pressure.
questionsmedicales.fr › Thérapeutique › Thérapie respiratoire › Ventilation artificielle › Ventilation à pression positive › Setting and Titrating Positive End-Expiratory Pressure.
questionsmedicales.fr › Maladies de l'appareil respiratoire › Troubles respiratoires › Syndrome de détresse respiratoire de l'adulte › Setting and Titrating Positive End-Expiratory Pressure.
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques respiratoires › Setting and Titrating Positive End-Expiratory Pressure.
questionsmedicales.fr › Équipement et fournitures › Respirateurs artificiels › Setting and Titrating Positive End-Expiratory Pressure.