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July 2, 2008

Ventilation Strategies for Acute Lung Injury and Acute Respiratory Distress Syndrome—Reply

JAMA. 2008;300(1):39-43. doi:10.1001/jama.300.1.42-b

In Reply: Dr Oba proposes an approach to setting PEEP during ALI/ARDS based on the following conceptual model: by applying higher levels of PEEP the lung will be recruited and, with the tidal volume distributed across a greater portion of lung parenchyma, the plateau pressure will decrease; ie, the compliance of the respiratory system will increase. After the recruitment, a further increase of PEEP would lead to alveolar overdistention, and the compliance of the respiratory system would decrease accordingly. Indeed, the “best PEEP” would coincide with the “best compliance.”