In ARDS management, what is the goal of using PEEP?

• A. Use maximal PEEP regardless of effects.
• B. Avoid any PEEP.
• C. Use moderate PEEP only to maintain oxygenation.
• D. Use adequate PEEP to recruit without causing overdistention; tailor to oxygenation targets and lung mechanics.

Answer: (D)

The goal of PEEP in ARDS is to recruit collapsed lung units and keep them open at end expiration, improving oxygenation, while avoiding overdistention and harm to the lung. Because ARDS lungs are heterogeneous, just increasing PEEP isn’t enough or always safe—you want enough PEEP to reopen and stabilize more alveoli, but not so much that healthy areas are stretched too far or venous return is impaired. In practice, PEEP is titrated to achieve adequate oxygenation with minimal ventilator-induced injury, guided by lung mechanics such as plateau pressure and driving pressure, and by oxygenation targets. A common safety target is keeping plateau pressure around or below 30 cm H2O and driving pressure as low as feasible while monitoring oxygenation; if higher PEEP improves oxygenation without generating overdistention or hemodynamic issues, it’s continued, otherwise it’s reduced. This individualized approach contrasts with using maximal or no PEEP, or applying moderate PEEP without considering lung mechanics and response.