Individualized positive end-expiratory pressure application in patients with acute respiratory distress syndrome.
Current treatment of acute respiratory distress syndrome is based on ventilatory support with a lung protective strategy, avoiding the development of iatrogenic injury, including ventilator-induced lung injury. One of the mechanisms underlying such injury is atelectrauma, and positive end-expiratory pressure (PEEP) is advocated in order to avoid it. The indicated PEEP level has not been defined, and in many cases is based on the patient oxygen requirements for maintaining adequate oxygenation. However, this strategy does not consider the mechanics of the respiratory system, which varies in each patient and depends on many factors-including particularly the duration of acute respiratory distress syndrome. A review is therefore made of the different methods for adjusting PEEP, focusing on the benefits of individualized application.
Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España. Electronic address: consuelopintado@yahoo.es.
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Pintado
Unidad de Cuidados Intensivos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
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de Pablo
D006439:Hemodynamics; D006801:Humans; D008170:Lung Compliance; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration / Q000379:methods*; D057285:Precision Medicine; D001261:Pulmonary Atelectasis / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D015656:Respiratory Mechanics
D010100:Oxygen
Acute respiratory distress syndrome; Lesión pulmonar inducida por el respirador; Mechanical ventilation; Positive end-expiratory pressure; Presión positiva al final de la espiración; Síndrome de distrés respiratorio agudo; Ventilación mecánica; Ventilator-induced lung injury