Global versus regional effects of PEEP on recruitment and strain: insights from preclinical and clinical studies

Journal of Applied Physiology 2026 Open access

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Authors: Luca Salvatore Menga, Mayson L A Sousa, Nannan Sun, Rollin Roldán, C. Brault, Mariangela Pellegrini, Matthew Ko, L. Felipe Damiani, Vorakamol Phoophiboon, S. Dubó, Fernando Vieira, Antenor Salzer Rodrigues
+6 more Mattia Docci, Lu Chen, Annia Schreiber, AS Slutsky, Martin Post, Laurent Brochard
DOI: 10.1152/japplphysiol.00948.2025
Cited by: 4
References: 37

Abstract

Dorsal regions are more recruitable than ventral, decreasing their dynamic strain with PEEP, but relative PEEP effects vary across ARDS phenotypes with different global recruitability. The higher the global recruitability, the higher the effect on the dorsal part. This was demonstrated across two acute lung injury (ALI) animal models and two patient cohorts, mixed ARDS, and COVID-19 ARDS. PEEP can paradoxically increase dynamic dorsal strain despite recruitability if ventral overdistention occurs. EIT can detect this.

Fields of Study & Subjects

Respiratory Support and Mechanisms Neonatal Respiratory Health Research Sepsis Diagnosis and Treatment

Publication details

Journal / source
Journal of Applied Physiology
Publisher
American Physiological Society
Volume
140
Issue
3
Pages
764–777
Publication date
5 February 2026
Language
EN