Raising positive end-expiratory pressures in ARDS to achieve a positive transpulmonary pressure does not cause hemodynamic compromise

摘要

High positive end-expiratory pressure (PEEP) is associated with improved survival in patients with moderate to severe acute respiratory distress syndrome (ARDS) [1], but high PEEP has also been reported to cause right heart failure and hemodynamic compromise [2]. In our previous trial of ventilator management in ARDS [3], setting PEEP to achieve a positive transpulmonary pressure estimated using esophageal manometry usually increased PEEP, often significantly, but also led to better blood oxygena-tion and respiratory compliance than the control PEEP.