Titrating PEEP in ARDS

Key Principles:

1) The ideal PEEP optimizes alveolar recruitment and reduces atelectrauma, while minimizing over-distension and barotrauma

2) Variables to monitor with PEEP titrations are:

  • Plateau pressure (Pplat)

  • Driving pressure (ΔP = Pplat - PEEP)

  • Oxygenation

  • Blood pressure

3) No one method has proven to be the superior option for titrating PEEP

4) Optimal PEEP is dynamic, and should be re-assessed frequently

5) High-PEEP recruitment maneuvers are harmful and should be avoided

Optimize PEEP with one of these methods:

  • Driving Pressure and Incremental / Decremental PEEP trial

  • Esophageal Manometry

  • Pressure - Volume Loop

  • Stress Index



By @PulmPEEPs



#PEEP #ARDS #titration #management #criticalcare #pulmonary