What are the benefits and harms of high versus low levels of positive end-expiratory pressure (PEEP) in adults with acute lung injury and acute respiratory distress syndrome (ARDS)?

Acute lung injury generally refers to acute respiratory insufficiency with decreased lung compliance leading to tachypnea and cyanosis.1  A life-threatening form of acute lung injury, ARDS, is classified according to the degree of hypoxemia based on the ratio of Pao2 to fraction of inspired oxygen, ranging from mild at 200 to severe at less than or equal to 100. Acute respiratory distress syndrome is common in the intensive care unit setting and is associated with significant morbidity and mortality.2  One study examining the epidemiology of ARDS across several countries found that approximately 10% of all patients admitted to the intensive care unit and 23% of all patients requiring mechanical ventilation developed ARDS.3 

Even though research has been conducted...

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