Negative Effects

• Can worsen gas exchange
  
• Decreases venous return and preload
  
• Decreases cardiac output (CO)
  
• Can cause hypotension and organ hypoperfusion
  
• Can cause barotrauma
  
• Can increase intracranial pressure (ICP)

PEEP in practice

• Start with a PEEP of 5cm H₂O
  
• PEEP by 2–3cm H₂O every 30–60 minutes to achieve SaO₂ > 88% or PaO₂> 55 mm Hg
  
• Refer to ARDS Net table for combination recommendations
  
• Call for help if you reach a PEEP of 15 and there is no improvement

ARDS Net original PEEP/ FiO₂ combination recommendation

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