Gas exchange and lung mechanics in patients with acute respiratory distress syndrome: Comparison of three different strategies of positive end expiratory pressure selection

Impact of 3 strategies of PEEP selection in 20 ARDS patients on Ptpe (C), Ptpi (B), and SI (A). In 35% of the patients, PEEP selection according to ARDS network PEEP/Fio2 table induced negative Ptpe, suggesting alveolar collapse. On the other hand, the ExPress strategy (PEEP level to reach plateau pressure of 28-30 cm H2O) induced SI greater than or equal to 1.1 in 30% of the patients, suggesting alveolar overdistension. The Best Compliance approach (PEEP selection in the decremental PEEP curve after a recruitment maneuver) did not induce increase of the SI, and there was mild risk of lung collapse (only 3 patients had negative Ptpe).38