PEEP and lung tissue injury by mechanical ventilation

When alveolar collapse occurs during expiration, the next positive pressure breath must 'snap open' this alveolar unit before gas can enter. Repetitive collapsing and snapping open appears to potentiate the shear stress and parenchymal injury from mechanical ventilation. PEEP seems to decrease the severity of ventilator-induced lung damage (Dreyfuss.and Saumon 1993) at both low and high tidal volumes. However, PEEP can increase end-inspiratory lung distension and thus the potential danger of alveolar rupture and barotrauma. Outcome in patients with acute respiratory failure is potentially improved when low tidal volumes and PEEP at a sufficient level to keep the lung open are used (SJutsky.1994).

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