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.”
Gattinoni L, Caironi P. 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
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