title: PEEP titration during prone positioning for acute respiratory distress syndrome.
abstract: No major trial evaluating prone positioning for acute respiratory distress syndrome (ARDS) has incorporated a high-positive end-expiratory pressure (high-PEEP) strategy despite complementary physiological rationales. We evaluated generalizability of three recent proning trials to patients receiving a high-PEEP strategy. All trials employed a relatively low-PEEP strategy. After protocol ventilator settings were initiated and the patient was positioned per treatment assignment, post-intervention PEEP was not more than 5 cm H2O in 16.7 % and not more than 10 cm H2O in 66.0 % of patients. Post-intervention PEEP would have been nearly twice the set PEEP had a high-PEEP strategy been employed. Use of either proning or high-PEEP likely improves survival in moderate-severe ARDS; the role for both concomitantly remains unknown.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, 200 West Arbor Drive, San Diego, CA, 92103, USA. jbeitler@ucsd.edu.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Beitler
authors.affiliation: Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Université de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.|INSERM 955 Eq.13, Créteil, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Guérin
authors.affiliation: Centre de Coordination et de Lutte contre les Infections Nosocomiales Sud-Est, Hôpital Henri Gabrielle, 20 Routes de Vourles, 69230, Saint-Genis-Laval, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Ayzac
authors.affiliation: Servei de Medicina Intensiva, Hospital de Sant Pau, Avinguda Sant Antoni Maria Claret 167, 08025, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Mancebo
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, 200 West Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Dina M
authors.initials: DM
authors.lastname: Bates
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, 200 West Arbor Drive, San Diego, CA, 92103, USA.
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Talmor
mesh_terms: D006801:Humans; D011175:Positive-Pressure Respiration / Q000379:methods*; D016684:Prone Position; D012128:Respiratory Distress Syndrome / Q000451:nursing / Q000473:pathology / Q000628:therapy*