High versus low positive end-expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome

Context is Key: Applying Lessons From Retrospective Studies of COVID-19 Associated Pneumomediastinum

“…Multiple studies have found that the presence of PM is not associated with increased mortality in ARDS associated with other viral pneumonias. [16][17][18][19] Similar studies have also found an increase in ARDS associated mortality with pneumothorax or barotrauma in general. [20][21][22] High quality research and methodology should be the rule of every scientific study during normal times, and even more so during the crisis of a global pandemic and for these Reis et al should be congratulated for presenting their work in the Journal of Intensive Care Medicine.…”

Optimal positive end-expiratory pressure reduces right ventricular dysfunction in COVID-19 patients on venovenous extracorporeal membrane oxygenation: A retrospective single-center study

“…This improvement in pulmonary vascular resistance (PVR) may reduce the afterload imposed on the RV [ 12 , 13 ]. While it makes physiologic sense that reducing PVR, and thus RV afterload, by optimizing PEEP may reduce the incidence of RV dysfunction, the optimal level of PEEP in ARDS remains unclear and a higher PEEP strategy has not reduced mortality relative to a lower PEEP strategy [ 14 ]. Our findings are consistent with previously published data on the incidence of RV dysfunction in ARDS, its negative effect on mortality, and the potentially beneficial effects of optimized PEEP on ECMO survival [ [3] , [4] , [5] , [6] , [7] , 9 ].…”

Is severe traumatic brain injury no longer a contraindication for surgical stabilization of rib fractures in patients with multiple rib fractures? A propensity-matched analysis

“…While lung protective ventilation is preferred in thoracic trauma, 35 patients with chest wall injury and lung contusion may require high positive end-expiratory pressure (PEEP) to maximize alveolar recruitment and achieve adequate blood oxygenation. 36 However, elevated levels of PEEP are associated with higher levels of central venous pressure, ICP, and lower mean arterial pressure because of a decrease in venous return and cardiac output. 37,38 Higher ICP and low mean arterial pressure have been shown to negatively impact patient outcomes in patients with TBI.…”

“…Mechanical ventilation is a cornerstone in the ICU management of both severe TBI and unstable chest wall injuries. While lung protective ventilation is preferred in thoracic trauma, 35 patients with chest wall injury and lung contusion may require high positive end-expiratory pressure (PEEP) to maximize alveolar recruitment and achieve adequate blood oxygenation 36 . However, elevated levels of PEEP are associated with higher levels of central venous pressure, ICP, and lower mean arterial pressure because of a decrease in venous return and cardiac output 37,38 .…”