While initially ventilating a patient with ARDS, the extrinsic PEEP should be maintained using which method?

• A. Open lung approach
• B. Plateau pressure strategy
• C. Inverse ratio ventilation
• D. No PEEP

Answer: (A)

In ARDS, the goal during initial ventilation is to recruit collapsed alveoli and then keep them open to prevent derecruitment, which improves oxygenation and reduces shunt. The Open Lung Approach does exactly that: it uses a recruitment maneuver to open collapsed units and then applies an appropriate level of PEEP to hold those units open at end-expiration. This balance helps maintain alveolar recruitment while avoiding excessive pressure that could cause injury, often with attention to limiting plateau pressure and driving pressure. The plateau pressure strategy centers on keeping pressures down but doesn’t specify how to sustain recruitment with PEEP. Inverse ratio ventilation can raise mean airway pressure to aid oxygenation but isn’t a recruitment/PEEP-teaching approach. No PEEP would promote rapid derecruitment and poor oxygenation. So, maintaining extrinsic PEEP in this context is best done with the Open Lung Approach.