1. PEEP titration during prone positioning for acute respiratory distress syndrome
- Author
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Jordi Mancebo, Louis Ayzac, Jeremy R. Beitler, Dina M. Bates, Daniel Talmor, Claude Guérin, and Atul Malhotra
- Subjects
Adult ,ARDS ,Clinical Trials and Supportive Activities ,Acute respiratory distress ,Critical Care and Intensive Care Medicine ,Medical and Health Sciences ,Positive-Pressure Respiration ,Viewpoint ,Rare Diseases ,Clinical Research ,Ventilator settings ,Prone Position ,RESPIRATORY DISTRESS SYNDROME ADULT ,Medicine ,Humans ,Lung ,Acute Respiratory Distress Syndrome ,Respiratory Distress Syndrome ,business.industry ,respiratory system ,medicine.disease ,Emergency & Critical Care Medicine ,respiratory tract diseases ,Prone position ,Anesthesia ,Patient Safety ,business ,therapeutics ,circulatory and respiratory physiology - 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 H2O in 16.7 % and not more than 10 cm H2O 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.
- Published
- 2015
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