Presión positiva teleespiratoria alta o convencional en el síndrome de distrés respiratorio agudo / High or conventional positive end-expiratory pressure in acute respiratory distress

En el síndrome de distrés respiratorio agudo se puede necesitar una presión positiva teleespiratoria (PEEP) elevada, sin embargo, no se ha llegado a determinar cuánto. Varios ensayos clínicos han comparado esos niveles con los convencionales en este síndrome. Globalmente, aunque la PEEP elevada mejora la oxigenación y es segura, no mejora la mortalidad. No obstante, los metaanálisis han puesto de manifiesto 2 situaciones en las que una PEEP elevada puede disminuir la mortalidad: en el síndrome de distrés respiratorio agudo grave y cuando se titula mediante las características de la mecánica pulmonar. Cinco estudios han explorado esto último, todos de pequeño tamaño muestral, usando diferentes maneras de determinar la PEEP óptima. Resulta necesario, por tanto, realizar un estudio con el suficiente tamaño muestral que compare el tratamiento de pacientes con síndrome de distrés respiratorio agudo grave mediante una estrategia de ventilación protectora, con PEEP elevada, guiada por las características de la mecánica pulmonar y la ventilación según el protocolo de la ARDS Network

Patients with acute respiratory distress syndrome may require high positive endexpiratory pressure (PEEP) levels, though the optimum level remains to be established. Several clinical trials have compared high PEEP levels versus conventional PEEP. Overall, although high PEEP levels improve oxygenation and are safe, they do not result in a significant reduction of the mortality rates. Nevertheless, some metaanalyses have revealed 2 situations in which high PEEP may decrease mortality: When used in severe distress and when PEEP is set following thec haracteristics of lung mechanics. Five studies have explored this latter scenario. Unfortunately, all of them have small sample sizes and have used different means to determine optimum PEEP. It is therefore necessary to conduct studies of sufficient sample size to compare the treatment of patients with severe acute respiratory distress syndrome, using a protective ventilation strategy with high PEEP guided by the characteristics of lung mechanics and ventilation with the protocol proposed by the ARDS Network

High or conventional positive end-expiratory pressure in adult respiratory distress syndrome.

Patients with acute respiratory distress syndrome may require high positive end-expiratory pressure (PEEP) levels, though the optimum level remains to be established. Several clinical trials have compared high PEEP levels versus conventional PEEP. Overall, although high PEEP levels improve oxygenation and are safe, they do not result in a significant reduction of the mortality rates. Nevertheless, some metaanalyses have revealed 2 situations in which high PEEP may decrease mortality: When used in severe distress and when PEEP is set following the characteristics of lung mechanics. Five studies have explored this latter scenario. Unfortunately, all of them have small sample sizes and have used different means to determine optimum PEEP. It is therefore necessary to conduct studies of sufficient sample size to compare the treatment of patients with severe acute respiratory distress syndrome, using a protective ventilation strategy with high PEEP guided by the characteristics of lung mechanics and ventilation with the protocol proposed by the ARDS Network.