Bedside selection of positive end-expiratory pressure in mild, moderate, and severe acute respiratory distress syndrome.

Objective:�Positiveend-expiratorypressureexertsitseffectskeep- ingopenatend-expirationpreviouslycollapsedareasofthelung;� consequently,�higherpositiveend-expiratorypressureshouldbe� limitedtopatientswithhighrecruitability.�Weaimedtodetermine� whichbedsidemethodwouldprovidepositiveend-expiratory� pressurebetterrelatedtolungrecruitability. Design:�Prospectivestudyperformedbetween�2008�and�2011. Setting:�Twouniversityhospitals�(ItalyandGermany). Patients:�Fifty-onepatientswithacuterespiratorydistresssyndrome. Interventions:�WholelungCTscansweretakeninstaticcondi- tionsat�5�and�45�cmH2Oduringanend-expiratory/end-inspiratory� pausetomeasurelungrecruitability.�Toselectindividualpositive� end-expiratorypressure,�weappliedbedsidemethodsbasedon� lungmechanics�(ExPress,�stressindex),�esophagealpressure,�and� oxygenation�(higherpositiveend-expiratorypressuretableoflung� openventilationstudy).