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Previous Volume 351:327-336 July 22, 2004 Number 4 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Levy, M. M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Most patients requiring mechanical ventilation for acute lung injury and the acute respiratory distress syndrome (ARDS) receive positive end-expiratory pressure (PEEP) of 5 to 12 cm of water. Higher PEEP levels may improve oxygenation and reduce ventilator-induced lung injury but may also cause circulatory depression and lung injury from overdistention. We conducted this trial to compare the effects of higher and lower PEEP levels on clinical outcomes in these patients.

Methods We randomly assigned 549 patients with acute lung injury and ARDS to receive mechanical ventilation with either lower or higher PEEP levels, which were set according to different tables of predetermined combinations of PEEP and fraction of inspired oxygen.

Results Mean (±SD) PEEP values on days 1 through 4 were 8.3±3.2 cm of water in the lower-PEEP group and 13.2±3.5 cm of water in the higher-PEEP group (P<0.001). The rates of death before hospital discharge were 24.9 percent and 27.5 percent, respectively (P=0.48; 95 percent confidence interval for the difference between groups, –10.0 to 4.7 percent). From day 1 to day 28, breathing was unassisted for a mean of 14.5±10.4 days in the lower-PEEP group and 13.8±10.6 days in the higher-PEEP group (P=0.50).

Conclusions These results suggest that in patients with acute lung injury and ARDS who receive mechanical ventilation with a tidal-volume goal of 6 ml per kilogram of predicted body weight and an end-inspiratory plateau-pressure limit of 30 cm of water, clinical outcomes are similar whether lower or higher PEEP levels are used.

Source Information

The members of the Writing Committee (Roy G. Brower, M.D., Johns Hopkins University, Baltimore; Paul N. Lanken, M.D., University of Pennsylvania, Philadelphia; Neil MacIntyre, M.D., Duke University, Durham, N.C.; Michael A. Matthay, M.D., University of California, San Francisco, San Francisco; Alan Morris, M.D., LDS Hospital, Salt Lake City; and Marek Ancukiewicz, Ph.D., David Schoenfeld, Ph.D., and B. Taylor Thompson, M.D., Massachusetts General Hospital, Boston) of the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network assume responsibility for the integrity of the article.

Address reprint requests to Dr. Brower at Johns Hopkins University, 1830 East Monument St., Rm. 549, Baltimore, MD 21205.

Full Text of this Article

Related Letters:

High versus Low PEEP in ARDS
Perren A., Rotta A. T., Brower R., Morris A., MacIntyre N., the National Heart, Lung and Blood Institute ARDS Clinical Trials Network , Levy M. M.
Extract | Full Text | PDF  
N Engl J Med 2004; 351:2128-2129, Nov 11, 2004. Correspondence

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