Is there any need for higher PEEP levels in ARDS patients?

Lung protective ventilation has been shown to reduce mortality in ARDS patients. Current guide- lines are focussed on lowering tidal volumes and mini- mizing mean airway pressures. In this review we dis- cuss possible future improvements to mechanical ven- tilation; especially the open lung maneuver. We dis- cuss the rationale for the use of higher PEEP levels in ARDS patients, using data from animal and human studies. Finally, guidelines for future strategies and/ or investigations are presented.