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Editorials: POINT/COUNTERPOINT EDITORIALS |

Counterpoint: Should Positive End-Expiratory Pressure in Patients With ARDS Be Set Based on Oxygenation? NoPEEP in Patients With ARDS Set on Oxygenation: No

Gregory A. Schmidt, MD, FCCP
Author and Funding Information

From the Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa.

Correspondence to: Gregory A. Schmidt, MD, FCCP, Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa, 200 Hawkins Dr, C304-GH, Iowa City, IA 52246; e-mail: Gregory-a-schmidt@uiowa.edu


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1382-1384. doi:10.1378/chest.12-0157
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Extract

Nearly 40 years ago, novel animal studies laid the foundation for lung-protective ventilation. Both lung overdistention and the absence of positive end-expiratory pressure (PEEP) were linked to gross and histologic lung injury.1 Tidal volume was shown subsequently to be clinically important: 6 mL/kg compared with 12 mL/kg predicted body weight reduced absolute mortality by 9% in patients with acute lung injury (ALI) or ARDS.2 PEEP is biologically relevant, too: Limiting tidal recruitment and derecruitment reduces lung inflammation.3,4,5,6 Yet PEEP may provoke deleterious effects, so that choosing the appropriate level requires balancing benefits and costs. In addition, PEEP should be individualized—in the right amount, to those most likely to benefit.

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