Critical care clinics
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Critical care clinics · Jan 2002
ReviewMechanical ventilation in acute lung injury and ARDS. Tidal volume reduction.
Traditional mechanical ventilation practices used generous tidal volumes in patients with acute lung injury and acute respiratory distress syndrome (ALI/ARDS). This approach may have caused overdistention of aerated lung units, thus exacerbating lung injury in some patients. ⋯ This article reviews the rationale for tidal volume reduction in ALI/ARDS and the differences between the studies. Several different interpretations of the recent clinical trial results are addressed.
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Critical care clinics · Jan 2002
ReviewOptimal peep in ARDS. Changing concepts and current controversies.
From many recently performed studies, it is clear that a criterion standard for determining the optimal positive end-expiratory pressure (PEEP) level in patients with acquired respiratory distress syndrome (ARDS) does not exist. What is evident and consistent, however, are several points such the optimal PEEP level ultimately represents a balance between regional areas of overstretching and regional derecruitment; higher levels of PEEP may be required early in ARDS, independent of oxygenation requirements; and the exact method for titrating PEEP in patients with ARDS remains to be determined. These points and others are delineated and discussed in this article.