Before our LUNG sessions today... a quick look at what we already know about PPV and PEEP in ICU... #ESICMphysio #FOAMed 
We've been looking at MV for decades. In 1986 - a good summary was published about its deleterious effects... Life saving yes, but nurses and doctors agreed it came with profound sequelae... #FOAMed #ESICMphysio ncbi.nlm.nih.gov/pubmed/9564354 and ncbi.nlm.nih.gov/pubmed/3530039
In 2008 a great reflection was published in BJA - which did summarise that "Ventilation with PEEP is a proven, effective modality in both anaesthesia and ICU, despite the immense physiological derangement it causes" #ESICMphysio academic.oup.com/bja/article/10…
From this paper, there were a number of Q's posed: #ESICMphysio - primarily ARE THERE ALTERNATIVES? #FOAMed Today of course, we utilise ECMO to a certain degree, but has PPV changed since 2008?
derangedphysiology.com/main/cicm-prim… has a really good summary article about the effects of PPV - it's remarkably thorough! #FOAMed #ESICMphysio
As for PEEP - we should take a glance at @ccpractitioner's work on this for a great summary overview on the basic physics. criticalcarepractitioner.co.uk/mechanical-ven… Most of the work on PEEP started in 1984 when looking at frozen dog lungs.... #FOAMed #ESICMphysio
StatPearls in 2019, have a good summary about the clinical significance of PEEP and some practical advice: ncbi.nlm.nih.gov/books/NBK44190…
To understand current conundrums - you need to read some info on 'THE OPEN LUNG' --> here: ccforum.biomedcentral.com/articles/10.11… as well as bmcanesthesiol.biomedcentral.com/articles/10.11… - which looks at HIGHER levels of PEEP in ARDS patients and their outcomes.
With these in mind, we can summarise some of the big benefits of PEEP and some of the problems... via @LITFLblog litfl.com/positive-end-e… #ESICMphysio #FOAMed
Lots has been discussed about the problems and tribulations with PEEP over the year. A good literature summary can be found within this article: medintensiva.org/en-what-peep-l… #ESICMphysio #FOAMed
