PEEP titration during prone positioning for acute respiratory distress syndrome. Issue 1 (December 2015)

• Record Type: Journal Article
• Authors: Beitler, Jeremy; Guérin, Claude; Ayzac, Louis; Mancebo, Jordi; Bates, Dina; Malhotra, Atul; Talmor, Daniel
• Is Part Of: Critical care. Volume 19:Issue 1(2015)
• Page Start: 1
• Page End: 6
• Publication Date: 2015-12
• Subjects: Critical care medicine -- Periodicals; 616.02805
• DOI: 10.1186/s13054-015-1153-9
• Languages: English
• ISSNs: 1364-8535

Abstract

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 H2 O in 16.7 % and not more than 10 cm H2 O 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.