The “open lung” compromise

Excerpt

How best to select positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome (ARDS) remains among the most actively debated questions of critical care practice. Controversy stems partially from imprecision of disease diagnosis, confusion about which objective to prioritize, and uncertainty regarding safe limits for airway pressure. Perhaps the root cause for such indecisiveness, however, involves the mechanical heterogeneity of the acutely diseased lung coupled with the need to set only one PEEP value. In fact, when lung protection is the issue, PEEP selection is always a tradeoff between improving recruitment and increasing tissue stress. The article by Di Rocco and colleagues in this issue [1] offers novel experimental data that address how that compromise is best struck. …