From the Guidelines
The normal range for Positive End-Expiratory Pressure (PEEP) in mechanical ventilation is typically 5-10 cmH2O for most patients requiring respiratory support, with higher values of 10-15 cmH2O or up to 20 cmH2O sometimes necessary for patients with Acute Respiratory Distress Syndrome (ARDS) 1.
Key Considerations for PEEP Settings
- For patients with normal lungs, a PEEP of 5 cmH2O is often used as the standard starting point to prevent alveolar collapse at the end of expiration.
- In patients with ARDS, the PEEP level should be individualized based on the patient's specific condition, oxygenation requirements, and hemodynamic status.
- PEEP settings should be adjusted according to arterial blood gas results and clinical response, with the goal of maintaining adequate oxygenation and preventing atelectasis.
- Clinicians should monitor for potential adverse effects of PEEP, such as decreased cardiac output, barotrauma, or increased intracranial pressure.
Evidence-Based Recommendations
- A recent study published in 2020 found that higher PEEP values were associated with improved oxygenation and reduced mortality in patients with moderate to severe ARDS 1.
- Another study published in 2024 found that the use of electrical impedance tomography (EIT) to guide PEEP settings improved respiratory mechanics and potentially outcomes in ARDS patients 1.
- The Surviving Sepsis Campaign recommends using higher PEEP in adult patients with sepsis-induced moderate to severe ARDS, with a weak recommendation and moderate quality of evidence 1.
From the Research
Normal PEEP Range
The normal range for Positive End-Expiratory Pressure (PEEP) can vary depending on the patient's condition and the specific ventilation strategy being used.
- In patients with acute respiratory distress syndrome (ARDS), a PEEP range of 6-12 cm H2O is commonly used 2.
- Some studies have used higher PEEP levels, up to 15-20 cm H2O, in patients with severe ARDS 3, 4.
- The optimal PEEP level is often determined by the patient's response to ventilation, including their oxygenation and lung mechanics 5, 6.
Factors Influencing PEEP Levels
Several factors can influence the choice of PEEP level, including:
- The severity of ARDS, with higher PEEP levels often used in more severe cases 3, 5
- The patient's lung mechanics, including their compliance and resistance 2, 6
- The use of other ventilation strategies, such as prone positioning and low tidal volume ventilation 3, 5
Clinical Outcomes
The use of higher PEEP levels has been associated with improved clinical outcomes in some studies, including: