{"id":786,"date":"2016-02-01T15:26:13","date_gmt":"2016-02-01T15:26:13","guid":{"rendered":"http:\/\/hfhpulm.com\/info\/?p=786"},"modified":"2016-02-01T15:26:13","modified_gmt":"2016-02-01T15:26:13","slug":"peep-ards","status":"publish","type":"post","link":"https:\/\/hfhpulm.com\/info\/?p=786","title":{"rendered":"PEEP in ARDS"},"content":{"rendered":"<p>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 H<sub><small>2<\/small><\/sub>O, and F<small>IO<\/small><sub><small>2<\/small><\/sub> 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 H<sub><small>2<\/small><\/sub>O to address the low arterial oxygenation saturation.<\/p>\n<p>Which of the following observations after an increase in PEEP is most predictive of improved survival?<\/p>\n<div class=\"CHOICE\" style=\"text-align: left\">a) An increase in physiologic dead-space ventilation (Vd\/Vt)<\/div>\n<div class=\"CHOICE\" style=\"text-align: left\">\n<div class=\"CHOICE\">b) An increase in plateau pressure (Pplat)-PEEP pressure gradient<\/div>\n<p>c) A decrease in Pplat-PEEP pressure gradient<\/p><\/div>\n<div class=\"CHOICE\" style=\"text-align: left\">d) An increase in Pa<small>O<\/small><sub><small>2<\/small><\/sub> within 15 minutes<\/div>\n<div class=\"CHOICE\"><\/div>\n<div class=\"CHOICE\">\n<p>See Principles of Critical Care by Hall and Schmidt Chapter 52 pp 449-470 for an overview of ARDS physiology<\/p>\n<\/div>\n<div class=\"CHOICE\">Some articles:<\/div>\n<p>http:\/\/www.nejm.org\/doi\/pdf\/10.1056\/NEJMoa032193\u00a0 Higher vs lower PEEP in patients with ARDS<\/p>\n<p>http:\/\/jama.jamanetwork.com\/article.aspx?articleid=185447\u00a0 Review and Meta-analysis of Higher vs lower PEEP in patients with ALI and ARDS<\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2016\/02\/PC-1-192.pdf\">PC-1-192<\/a>\u00a0 A clinical review of ARDS<\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2016\/02\/ajrccm%2E164%2E5%2E2006071.pdf\">ajrccm%2E164%2E5%2E2006071 <\/a>Alveolar Derecruitment at detrimental PEEP<\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2016\/02\/rccm%2E200702-193oc.pdf\">rccm%2E200702-193oc<\/a>\u00a0\u00a0\u00a0 ARDSnet Ventilatory Protocol and alveolar hyperinflation<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[9],"tags":[],"class_list":["post-786","post","type-post","status-publish","format-standard","hentry","category-micu"],"modified_by":"Geneva Tatem","_links":{"self":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/786","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=786"}],"version-history":[{"count":2,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/786\/revisions"}],"predecessor-version":[{"id":791,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/786\/revisions\/791"}],"wp:attachment":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=786"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=786"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=786"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}