Personalized PEEP, options for getting it just right: An inf
The present infographic has been published in the recent issue of the journal Anesthesiology. An accompanying editorial "Lung-protective Ventilation in the Operating Room: Individualized Positive End-expiratory Pressure Is Needed!" further highlights the concent of PEEP.

The concept of lung-protective ventilation is well established in patients with acute lung injury and is now considered a fundamental approach when managing any patient under mechanical ventilation in an intensive care unit.

The concept of lung-protective ventilation in the operating room has taken a little longer to develop, but data establishing the beneficial results of intraoperative lung-protective ventilation are increasing. Regardless of location, it has become well accepted that tidal volume (VT) should be maintained between 4 and 8 ml/kg of predicted body weight, that plateau pressure should be maintained at less than 28 cm H2O, and that driving pressure (plateau pressure minus end-expiratory pressure [PEEP]) should be maintained at less than 15 cm H2O.

However, the establishment of guidelines for the setting of PEEP in any of these settings has been very challenging. There are no guidelines for PEEP setting based on the results of randomized controlled trials. In fact, the current literature is nonconclusive. The only established guideline is that patients with moderate-to-severe acute respiratory distress syndrome require “high” PEEP levels, whereas patients with mild adult respiratory distress syndrome require “low” PEEP.

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