PEEP Selection: Dynamic Elastance versus An Over-distension Measurement

Acute respiratory distress syndrome (ARDS) patients usually require support from ventilation in the intensive care unit (ICU). Recruitment maneuvers (RMs) with positive-end-expiratory-pressure (PEEP) are a common way to recruit alveoli and improve oxygenation. However, excessive PEEP can worsen alveoli status and thus increase the risk of ventilator-induced lung injury (VILI). To date, standards for optimal patient-specific PEEP determination remain unclear, resulting in variability and uncertainty in care and thus requiring personalized care approaches. This research examines the conventional approach, dynamic elastance ( E dyn ), and a validated over-distension index (OD) from prior work identified from pressure-volume curves. Overall, in the studied pilot trial, the optimal PEEP selection outcome matches between E dyn and OD methods within 0-2cmH 2 O (0-1 PEEP levels) variation for 16 out of 18 patients. The variation in the rest 2 patients are 4cmH 2 O (2 PEEP levels). While possible limitation for E dyn is addressed and discussed, the over-distention index OD shows greater potential in routine care being more intuitive, general, and predictive.