PEEP redistributes tidal volume

At zero or low levels of PEEP, mechanical tidal ventilation is preferentially distributed to non-dependent lung zones ( Gattinoni etai 1995). With increasing PEEP, more tidal volume is shifted to dependent (i.e. paravertebral) regions in the supine patient. In acute lung injury due to edema, pneumonia, or acute respiratory distress syndrome, low levels of PEEP (0-10 cmH2O) produces less recruitment of collapsed alveolar space than tidal volume. However, at higher PEEP (12-20 cmH 2O) recruitment becomes important.

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