Use of positive end-expiratory pressure in acute respiratory distress syndrome: current views

Despite its wide application during mechanical ventilation of patients with acute respiratory distress syndrome, the correct setting of positive end-expiratory pressure is still an unsolved issue. We have recently observed that PEEP response is strictly correlated to the amount of the potentially recruitable lung, which is in turn associated to the overall severity of lung injury. Assessment of the potential for lung recruitment is therefore necessary for the correct setting of PEEP: a high PEEP level should be limited only to patients with a higher amount of potentially recruitable lung. At present, computed tomography represents the most accurate technique for its measurement.