In the treatment of ARDS, what level of PEEP is usually recommended?

In the treatment of Acute Respiratory Distress Syndrome (ARDS), the application of Positive End-Expiratory Pressure (PEEP) is crucial in improving oxygenation and lung mechanics. PEEP helps to recruit collapsed alveoli, increase functional residual capacity, and prevent further atelectasis, which is essential for patients with ARDS due to impaired gas exchange.

The recommendation for using higher levels of PEEP, particularly more than 10 cm H2O, is based on studies showing improved oxygenation and lung protective strategies in ARDS patients. By maintaining a higher PEEP, the recruited alveoli can better participate in gas exchange, thus enhancing the overall oxygen delivery to tissues. This strategy is particularly effective in the context of ARDS, where compliance is decreased, and shunting can occur due to collapsed lung units.

On the other hand, using lower levels of PEEP (such as less than 5 cm H2O) may not provide the needed recruitment of collapsed alveolar units and could lead to inadequate oxygenation. Levels in the 5-10 range may provide some benefit but generally do not achieve the same level of recruitment and improvement in oxygenation as seen with higher settings. Therefore, for optimal management of ARDS, employing P