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But again, although equivalent derecruitment did occur at lower PEEP levels, this study shows that most patients have significant derecruitment after most PEEP reductions, with no clear critical derecruitment level.
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In patients with ALI, the FRC decreased after each PEEP reduction step.
Not infrequently, in PEEP versus compliance curves, the relief of overdistension after a PEEP reduction overshadows the appearance of massive lung collapse.
If PaO2/FIO2 decreased to less than 300 during attempts of PEEP reduction, a new recruitment maneuver was repeated, and PEEP was restored to its previous level.
In patients with ALI/ARDS, the FRC decreased during each PEEP reduction, but whether the largest change in FRC indicates the optimal PEEP needs further research.
Transient desaturation at maximum PEEP during SRMs with subsequent augmentation of oxygen saturation higher than baseline with PEEP reduction has previously been described by our group [ 16] and by others [ 17].
Further, the combined increase in PEEP and reduction in VT in the protectively ventilated animals resulted in a higher mean airway pressure and a marginally lower plateau pressure.
Criteria for overinflation of lung (and therefore for discontinuation of further titration of PEEP) were reduction in PaO2 of 10% or more and an increase in arterial carbon dioxide tension of 10% or more.
Whatever the major component of PEEP-induced reduction in LV afterload may be, that decrease in afterload usually does not translate into increased cardiac output, as the adverse effects on LV filling usually predominate.
Finally, the decrease in cardiac output secondary to the increase in intrathoracic pressures has been demonstrated to account for a part of the PEEP-induced reduction in pulmonary edema [33].
Grade IV IAH did not protect against the PEEP-induced reduction in stroke volume and CO, most likely due to a reduced venous return associated with high levels of IAH [ 10, 31].
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