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

Lung protective ventilation has been shown to reduce mortality in ARDS patients. Current guidelines are focussed on lowering tidal volumes and minimizing mean airway pressures. In this review we discuss possible future improvements to mechanical ventilation; especially the open lung maneuver. We discuss 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.