Does positive end-expiratory pressure (PEEP) affect the natural history of acute lung injury?...Yes!
A review of the literature regarding PEEP and outcome demonstrates that there are a number of reasons why PEEP should be beneficial in acute lung injury. There is no doubt that it improves oxygenation, decreases the necessity for high oxygen concentrations, and perhaps improves alveolar function. In situations where lung injury is a major cause of mortality and where this lung injury is reversible, the benefits of PEEP outweigh the risks and survival is improved. This is true for the infant respiratory distress syndrome and, perhaps, when PEEP is used for postoperative pulmonary hygiene. In other situations, however, where lung injury can be substantial but is not the major cause of mortality, a beneficial outcome effect of PEEP, if indeed it has such an effect, will be a smaller one.
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