A 45-year-old previously healthy woman is admitted to the intensive care unit for bacterial pneumonia and severe acute respiratory distress syndrome. She undergoes rapid-sequence intubation with ketamine and rocuronium and receives volume-limited mechanical ventilation with a tidal volume of 6 mL/kg ideal body weight, positive end-expiratory pressure (PEEP) of 10 cm H2O, and FIO2 of 1.0. Arterial oxygen saturation by pulse oximetry is 82%. Blood pressure is stable without requirement for vasopressors. PEEP is increased to 15 cm H2O to address the low arterial oxygenation saturation.
Which of the following observations after an increase in PEEP is most predictive of improved survival?
c) A decrease in Pplat-PEEP pressure gradient
See Principles of Critical Care by Hall and Schmidt Chapter 52 pp 449-470 for an overview of ARDS physiology
http://www.nejm.org/doi/pdf/10.1056/NEJMoa032193 Higher vs lower PEEP in patients with ARDS
http://jama.jamanetwork.com/article.aspx?articleid=185447 Review and Meta-analysis of Higher vs lower PEEP in patients with ALI and ARDS
PC-1-192 A clinical review of ARDS
ajrccm%2E164%2E5%2E2006071 Alveolar Derecruitment at detrimental PEEP
rccm%2E200702-193oc ARDSnet Ventilatory Protocol and alveolar hyperinflation