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Acute Lung Injury (ALI) / Acute Respiratory Distress Syndrome (ARDS)
- ALI and ARDS are defined as:
- bilateral pulmonary infiltrates on CXR
- pulmonary capillary wedge pressure < 18 mm Hg (no heart failure)
- PaO2 / FiO2 < 300 = ALI
- PaO2 / FiO2 < 200 = ARDS
- The current management for patients with ALI or ARDS is low tidal volume ventilation and a conservative fluid management strategy
- Two recent trials (EXPRESS and LOVS) evaluated different applications of PEEP in patients with ALI/ARDS
- Both studies evaluated lower levels of PEEP (5-10) vs. higher levels of PEEP titrated to plateau pressure
- Bottom line: different PEEP strategies did not influence survival, although higher levels did result in improved oxygenation.