What is the role of the open lung approach in the treatment of acute respiratory distress syndrome (ARDS)?

Updated: Mar 27, 2020
  • Author: Eloise M Harman, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Another approach, favored by Amato et al, is the so-called open lung approach, in which the appropriate level is determined by the construction of a static pressure volume curve. [42] This is an S-shaped curve, and the optimal level of PEEP is just above the lower inflection point. Using this approach, the average PEEP level required is 15 cm water.

However, as noted above, an ARDS Network study of higher versus lower PEEP levels in ARDS patients did not find higher PEEP levels advantageous. [36] In this study, PEEP level was determined by how much inspired oxygen was required to achieve a goal oxygen saturation of 88-95% or a target partial pressure of oxygen (PO2) of 55-80 mm Hg. The PEEP level averaged 8 in the lower PEEP group and 13 in the higher PEEP group. No difference was shown in duration of mechanical ventilation or survival to hospital discharge.

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