PEEP, p-values, and pulmonary mechanics; don’t throw the baby out with the bathwater

Excerpt

We read with interest the viewpoint by Grieco and colleagues “Why compliance and driving pressure may be inappropriate targets for PEEP setting during ARDS” [1], written in response to our viewpoint, “Are we ready to think differently about PEEP?” [2]. We are delighted our article achieved its main objectives: generating attention to the urgent need to identify a physiology-based personalized PEEP strategy and highlighting the pitfalls of titrating PEEP based only on oxygenation measures. As we suggested, PEEP selection may be guided by seeking optimal compliance, simultaneously identifying least driving pressure for a given tidal volume, a measurement associated with important outcomes in acute respiratory distress syndrome (ARDS) [3]. …