- Ultimately, despite much research, the best method to set PEEP in patients with ARDS remains uncertain
- Several approaches have been suggested each with their own merits and problems:
Method
Steps
Adjust according to FiO2
- PEEP is adjusted according to the FiO2
- Protocols describe the use of PEEP tables to match the PEEP with the FiO2 – including that used in the original ARDSNET trial[AC1]
Lower Inflection point
- The pressure-volume loop can be used to determine the "critical opening pressure" of the alveoli
- PEEP can then be set to something slightly above this.
Maximal Static Compliance
- PEEP can be adjusted up or down to determine the maximal compliance
- Can be used in conjunction with a recruitment manoeuvre with PEEP decreased in 2cm H2O decrements and the point of maximal compliance determined
CT of the Chest
- CT scans can be used to visually determine the PEEP level which recruits the optimal amount of lung
- Usually reserved for the use of research purposes
Oesophageal Balloon Manometry
- Transpulmonary pressures can be used to establish transpulmonary pressures and optimise PEEP