Higher vs. lower PEEP in ARDS: just one part of the whole

Throughout the years the target of mechanical ventilation in acute respiratory distress syndrome (ARDS) patients has shifted from the maintenance of vital gas exchange to the protection of the lung from ventilator induced lung injury (VILI) (1,2). The unphysiological stress and strain of the “baby lung parenchyma”, the intra-tidal collapse of pulmonary and lung inhomogeneities units are the main determinants of VILI during mechanical ventilation resulting in inflammatory responses and mechanical lesions up to the lung rupture (3).