Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 314: Optimizing PEEP and Keeping Lungs Open in the ICU with Thomas Piraino and Brandon Oto
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Aug 10, 2025 
Join Thomas Piraino, a registered respiratory therapist and educator, along with Brandon Oto, a critical care physician assistant, as they dive into the intricacies of optimizing Positive End-Expiratory Pressure (PEEP) in the ICU. They discuss the importance of individualized patient care, explore decremental PEEP strategies for ARDS, and highlight advanced technologies like Electrical Impedance Tomography for real-time lung assessments. Their insights balance improving oxygenation with preventing lung injury, making this a must-listen for critical care professionals.
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PEEP Is A Patient-Specific Tradeoff
- PEEP balances keeping alveoli open against over-distending other regions and causing injury.
- The ideal PEEP varies by patient physiology and lung heterogeneity, not a universal number.
Start With ARDSnet Tables When Practical
- Use the ARDSnet PEEP/FiO2 table as a simple, safe starting strategy for many settings.
- Escalate to physiology-guided titration only if you can assess recruitability and monitor responses.
Best Compliance Can Hide Collapse
- Respiratory system compliance can mislead because tidal recruitment may mask collapse.
- Maximizing compliance can coincide with regional collapse, complicating PEEP selection.