title: High or conventional positive end-expiratory pressure in adult respiratory distress syndrome.
abstract: Patients with acute respiratory distress syndrome may require high positive end-expiratory pressure (PEEP) levels, though the optimum level remains to be established. Several clinical trials have compared high PEEP levels versus conventional PEEP. Overall, although high PEEP levels improve oxygenation and are safe, they do not result in a significant reduction of the mortality rates. Nevertheless, some metaanalyses have revealed 2 situations in which high PEEP may decrease mortality: When used in severe distress and when PEEP is set following the characteristics of lung mechanics. Five studies have explored this latter scenario. Unfortunately, all of them have small sample sizes and have used different means to determine optimum PEEP. It is therefore necessary to conduct studies of sufficient sample size to compare the treatment of patients with severe acute respiratory distress syndrome, using a protective ventilation strategy with high PEEP guided by the characteristics of lung mechanics and ventilation with the protocol proposed by the ARDS Network.
authors.affiliation: Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España. Electronic address: rda@uninet.edu.
authors.forename: R
authors.initials: R
authors.lastname: Díaz-Alersi
authors.affiliation: Servicio de Cuidados Críticos y Urgencias, Hospital Universitario Puerto Real, Puerto Real, Cádiz, España.
authors.forename: C
authors.initials: C
authors.lastname: Navarro-Ramírez
mesh_terms: D006801:Humans; D011175:Positive-Pressure Respiration / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000628:therapy*
keywords: Acute respiratory distress syndrome; Positive end-expiratory pressure; Presión positiva teleespiratoria; Protective ventilation; Síndrome de distrés respiratorio agudo; Ventilación protectora