PEEP titration guided by transpulmonary pressure: lessons from a negative trial

Since the first description of the acute respiratory distress syndrome (ARDS) by the landmark paper of Ashbaugh et al. (1), the adequate use of positive end-expiratory pressure (PEEP) has been surrounded by a vivid controversy. This stems from the fact that its beneficial effects on oxygenation by re-aerating collapsed or flooded airspaces, may be counterbalanced by potential adverse effects on hemodynamics and on the risk of increasing lung tissue mechanical stress.