FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 311:281-286 August 2, 1984 Number 5 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

Previous studies have suggested that the early application of positive end-expiratory pressure (PEEP) reduces the incidence of the adult respiratory-distress syndrome. We randomly assigned 92 patients with a known risk for this syndrome to receive mechanical ventilation either without PEEP (control) or with early PEEP at 8 cm H2O. These therapies continued for 72 hours unless respiratory distress developed or arterial oxygen tension was above 140 (fractional inspired oxygen concentration, 0.5) at 24 hours or later and remained at that level after removal of PEEP. The study was designed to have an 80 per cent probability of detecting a 60 per cent reduction in the incidence of the syndrome. The treatment groups were comparable in age, severity of injury, number and type of risk factors for adult respiratory-distress syndrome, and initial oxygenation. The syndrome developed in 11 of 44 patients given early PEEP (25 per cent) and in 13 of 48 control patients (27 per cent). The incidence of atelectasis, pneumonia, and barotrauma was the same in both groups, as was mortality. We found that the early application of PEEP at 8 cm H2O in high-risk patients had no effect on the incidence of the adult respiratory-distress syndrome or other, associated complications.

This article has been cited by other articles:

• Tsuchida, S., Engelberts, D., Roth, M., McKerlie, C., Post, M., Kavanagh, B. P. (2005). Continuous positive airway pressure causes lung injury in a model of sepsis. Am. J. Physiol. Lung Cell. Mol. Physiol. 289: L554-L564 [Abstract] [Full Text]  
• Rylander, C., Hogman, M., Perchiazzi, G., Magnusson, A., Hedenstierna, G. (2004). Functional Residual Capacity and Respiratory Mechanics as Indicators of Aeration and Collapse in Experimental Lung Injury. Anesth. Analg. 98: 782-789 [Abstract] [Full Text]  
• Ricard, J.-D., Dreyfuss, D., Cox, C. E., Carson, S. S. (2003). Evidence-based Medical Education: Caution. Am. J. Respir. Crit. Care Med. 168: 718-718 [Full Text]  
• Coss-Bu, J. A., Walding, D. L., David, Y. B., Jefferson, L. S. (2003). Dead Space Ventilation in Critically Ill Children With Lung Injury. Chest 123: 2050-2056 [Abstract] [Full Text]  
• Afifi, S. (2002). Lung Protective Ventilation Strategies. SEMIN CARDIOTHORAC VASC ANESTH 6: 259-269 [Abstract]  
• Eisner, M. D., Thompson, B. T., Schoenfeld, D., Anzueto, A., Matthay, M. A., the Acute Respiratory Distress Syndrome Network, (2002). Airway Pressures and Early Barotrauma in Patients with Acute Lung Injury and Acute Respiratory Distress Syndrome. Am. J. Respir. Crit. Care Med. 165: 978-982 [Abstract] [Full Text]  
• Ware, L. B., Matthay, M. A. (2000). The Acute Respiratory Distress Syndrome. NEJM 342: 1334-1349 [Full Text]  
• Kollef, M. H., Schuster, D. P. (1995). The Acute Respiratory Distress Syndrome. NEJM 332: 27-37 [Full Text]  
• Bickell, W. H., Wall, M. J., Pepe, P. E., Martin, R. R., Ginger, V. F., Allen, M. K., Mattox, K. L. (1994). Immediate versus Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries. NEJM 331: 1105-1109 [Abstract] [Full Text]  
• Grum, C. M., Morganroth, M. L. (1988). Analytic Reviews : Initiating Mechanical Ventilation. J Intensive Care Med 3: 6-20 [Abstract]  
• Courtney Broaddus, V., Berthiaume, Y., Biondi, J. W., Matthay, M. A. (1987). Analytic Reviews : Hemodynamic Management of the Adult Respiratory Distress Syndrome. J Intensive Care Med 2: 190-213 [Abstract]  
• Weigelt, J. A., Norcross, J. F., Borman, K. R., Snyder, W. H. III (1985). Early Steroid Therapy for Respiratory Failure. Arch Surg 120: 536-540 [Abstract]