Routine use of PEEP in mechanical ventilation

The only proven indication for PEEP is hypoxemia that is refractory to reasonable fractions of inspired oxygen. Yet, “five of PEEP” has become a default setting in mechanical ventilation no matter what the indication due to physiologic rationale and tradition. If cardiac decompensation (cardiogenic pulmonary edema) is in the loop of respiratory failure the physiologic rationale becomes even stronger because positive pressure applied anytime during the breathing cycle decreases afterload and has other hemodynamic benefits. That was the subject of this recent paper. The evidence is scant but PEEP appears to be safe and may offer clinical benefit when cardiac decompensation causes or complicates respiratory failure.