What is the optimal approach to weaning and liberation from mechanical ventilation?

Alistair D. Nichol, Pierce Geoghegan, Stephen Duff, David J. Cooper, David Devlin

Research output: Chapter in Book/Report/Conference proceedingChapter (Book)Otherpeer-review


The role of positive end-expiratory pressure (PEEP) in the management of acute respiratory distress syndrome (ARDS) has been apparent since the first description of the syndrome in the 1960s. The goal of respiratory support and mechanical ventilation in ARDS is to enable acceptable gas exchange while minimizing secondary ventilator-induced lung injury (VILI). Adjusting PEEP levels improves gas exchange by improving alveolar recruitment and by reducing intrapulmonary shunt. However, the application of PEEP may also contribute to VILI by causing alveolar overdistension, which may further contribute to lung inflammation and injury. This chapter reviews the role of PEEP and recruitment maneuvers as part of an effective lung protective ventilation strategy for ARDS.
Original languageEnglish
Title of host publicationEvidence-based practice of critical care
EditorsClifford S. Deutschman, Patrick J. Neligan
Place of PublicationPhiladelphia PA USA
Number of pages12
ISBN (Electronic)9780323640695
ISBN (Print)9780323640688
Publication statusPublished - 6 Sept 2019


  • critical care
  • intensive care
  • Intensive care medicine

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