Finding the optimal PEEP setting in ARDS patients is a difficult task, but also a very important one as high positive airway pressure may impact significantly on clinical outcomes. The choice of high vs. low PEEP should be based on the potential for lung recruitment, which can be assessed at the bedside using a low-flow inflation-deflation maneuver (usually 0-40 cmH20). But that is just the first step: Once the PEEP strategy has been selected - especially in patients with high potential the PEEP level needs some fine tuning. Could low-flow inflation-deflation maneuvers also be performed from PEEP to plateau pressure and back to PEEP again to assess whether the current PEEP is effective in avoiding tidal recruitment? Could these so-called "tidal P/V loops" help us select the PEEP value associated with the most protective combination of lung hyperinflation, lung derecruitment and atelectrauma?
Watch this presentation from Dr. Francesco Mojoli to find out more! He shares the results from a recent study* showing how P/V loops can be used to personalize PEEP in ways far beyond the initial recruitability assessment.
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