Application of positive end-expiratory pressure (PEEP) targeted towards improving oxygenation is one of the components of the ventilatory management of pediatric acute respiratory distress syndrome (PARDS). Low end-expiratory airway pressures cause repetitive opening and closure of unstable alveoli, leading to surfactant dysfunction and parenchymal shear injury. Consequently, there is less lung volume available for tidal ventilation when there are atelectatic lung regions. This will increase lung strain in aerated lung areas to which the tidal volume is preferentially distributed. Pediatric critical care practitioners tend to use low levels of PEEP and inherently accept higher FiO, but these practices may negatively affect patient outcome. The Pediatric Acute Lung Injury Consensus Conference (PALICC) suggests that PEEP should be titrated to oxygenation/oxygen delivery, hemodynamics, and compliance measured under static conditions as compared to other clinical parameters or any of these parameters in isolation in patients with PARDS, while limiting plateau pressure and/or driving pressure limits.

中文翻译：

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儿科重症监护病房的呼气末正压

应用呼气末正压 (PEEP) 来改善氧合是小儿急性呼吸窘迫综合征 (PARDS) 通气管理的组成部分之一。低呼气末气道压力导致不稳定的肺泡重复打开和关闭，导致表面活性剂功能障碍和实质剪切损伤。因此，当肺部区域存在肺不张时，可用于潮气通气的肺容量就会减少。这将增加潮气量优先分配的通气肺部区域的肺应变。儿科重症监护医师倾向于使用低水平的 PEEP，并且本质上接受较高的 FiO，但这些做法可能会对患者的治疗结果产生负面影响。小儿急性肺损伤共识会议 (PALICC) 建议，与其他临床参数或 PARDS 患者中的任何单独参数相比，PEEP 应根据静态条件下测量的氧合/氧气输送、血流动力学和依从性进行滴定，同时限制平台压力和/或驱动压力限制。