Mechanical ventilation with PEEP

For readers in a hurry, this summary may suffice. Mechanical ventilation with PEEP is a broad topic which has been the subject of extensive animal and clinical research in the decade since the first edition of this text. Many of the relevant basic concepts of heart-lung interaction are covered in detail in other chapters of this edition. This chapter will attempt to integrate basic mechanisms into the global effects of PEEP, and relate these concepts to patient care. In the past decade, there have been several new approaches to the delivery of mechanical ventilation such as inverse-ratio ventilation and partial liquid ventilation in acute respiratory distress syndrome (ARDS). There have also been further clinical insights into PEEP, such as appreciation of the prevalence and importance of auto-PEEP, and the use of PEEP in obstructive lung disease. The very purpose and goal of PEEP are changing. Typically, it has been used sparingly to minimize oxygen requirements in diffuse lung injury. Now it is now being advocated in more generous quantities to reduce lung injury associated with mechanical ventilation (1-3) and even to reduce inflammation (4).