Conditional value of raising positive end-expiratory pressure to counter vigorous breathing efforts in injured lungs [editorial]

Editorial Article

Difficult decisions often must be made regarding how much positive end-expiratory pressure (PEEP) to use and how much spontaneous breathing effort to allow in ventilated patients with acute lung injury. Because of mechanical heterogeneity, regional damage may occur when airway pressure excursions give rise to excessive local stretching forces or when strong diaphragmatic contractions cause intolerable fluctuations of regional pressure.