While initially ventilating a patient with acute respiratory distress syndrome (ARDS), the extrin-sic positive end-expiratory pressure (PEEPE) should be maintained using which of the following methods?
a. 50% of intrinsic positive end-expiratory pressure (PEEPI)
b. Open lung approach
c. Offset intrinsic PEEP
d. Minimize mean airway pressure
ANS: B
During the early phase of acute respiratory distress syndrome (ARDS), it is important to keep extrinsic positive end-expiratory pressure (PEEPE) high enough to at least exceed the inflection point on a slow or static pressure volume. It is generally accepted by clinicians that the deflation limb of a slow pressure-volume loop best approximates the end-expiratory pressure range required to prevent alveolar collapse. Maintaining PEEPE above this pressure range helps to prevent open-ing and closing of small airways and alveoli. This is referred to as the open lung approach to ven-tilatory management.
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