{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:31:22Z","timestamp":1786649482237,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,8]]},"abstract":"\n Background:<\/jats:title>\n Positive end-expiratory pressure (PEEP) is a crucial component of mechanical ventilation to improve oxygenation in critically ill patients with respiratory failure. The interaction between abdominal and thoracic compartment pressures is known well. Especially in intra-abdominal hypertension, lower PEEP may cause atelectotrauma by repetitive opening and closing of alveoli.<\/jats:p>\n <\/jats:sec>\n \n Aim:<\/jats:title>\n In this study, it was aimed to investigate the effect of PEEP adjustment according to the intra-abdominal pressure (IAP) on oxygenation and clarify possible harms.<\/jats:p>\n <\/jats:sec>\n \n Method:<\/jats:title>\n \n Patients older than 18 were mechanically ventilated due to hypoxemic respiratory failure and had normal IAP (<15 mmHg) included in the study. Patients with severe cardiovascular dysfunction were excluded. The following PEEP levels were applied: PEEPzero of 0 cmH2O, PEEP\n IAP\/2<\/jats:sub>\n = 50% of IAP, and PEEP\n IAP<\/jats:sub>\n = 100% of IAP. After a 30-minute equilibration period, arterial blood gases and mean arterial pressures were measured.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n One hundred thirty-eight patients (mean age 66.5 \u00b1 15.9, 56.5% male) enrolled on the study. The mean IAP was 9.8 \u00b1 3.4. Seventy-nine percent of the patients\u2019 PaO\n 2<\/jats:sub>\n \/FiO\n 2<\/jats:sub>\n ratio was under 300 mmHg. Figure 1 shows the change in PaO\n 2<\/jats:sub>\n \/FiO\n 2<\/jats:sub>\n ratio, PaCO\n 2<\/jats:sub>\n , PPlato, and MAP of the patients according to the PEEP levels. Overall increases were detected in the PaO\n 2<\/jats:sub>\n \/FiO\n 2<\/jats:sub>\n ratio (\n P<\/jats:italic>\n < 0.001) and Pplato (\n P<\/jats:italic>\n < 0.001), while PaCO\n 2<\/jats:sub>\n and MAP did not change after increasing PEEP gradually. Pairwise analyses revealed differences in PaO\n 2<\/jats:sub>\n \/FiO\n 2<\/jats:sub>\n between PEEPzero (186.4 [85.7\u2013265.8]) and PEEP\n IAP\/2<\/jats:sub>\n (207.7 [101.7\u2013292.9]) (t = -0.77,\n P<\/jats:italic>\n < 0.001), between baseline and PEEP\n IAP<\/jats:sub>\n (236.1 [121.4\u2013351.0]) (t = -1.7,\n P<\/jats:italic>\n < 0.001), and between PEEP\n IAP\/2<\/jats:sub>\n and PEEP\n IAP<\/jats:sub>\n (t = -1.0,\n P<\/jats:italic>\n < 0.001). Plato pressures were in the safe range (<30 cmH\n 2<\/jats:sub>\n O) at all three PEEP levels (PEEPzero = 12 [10\u201315], PEEP\n IAP\/2<\/jats:sub>\n = 15 [13\u201318], PEEP\n IAP<\/jats:sub>\n = 17 [14\u201322]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n In patients with acute hypoxemic respiratory failure and mechanically ventilated, PEEP adjustment according to the IAB improves oxygenation, especially in the settings of the limited source where other PEEP titration methods are absent.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/njcp.njcp_103_24","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T05:00:43Z","timestamp":1724648443000},"page":"1033-1037","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Optimizing Positive End-Expiratory Pressure Based on Intra-Abdominal Pressure in Patients with Acute Respiratory Failure"],"prefix":"10.4103","volume":"27","author":[{"given":"P","family":"Hanc\u0131","sequence":"first","affiliation":[{"name":"Department of Pulmonology Medicine, Division of Intensive Care, Trakya University Faculty of Medicine, Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ET","family":"Demir","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Division of Intensive Care, Atat\u00fcrk State Hospital, Turkish Ministry of Health, Ayd\u0131n, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"\u015eekerci","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ke\u015fan State Hospital, Turkish Ministry of Health, Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V","family":"\u0130nal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Intensive Care, Trakya University Faculty of Medicine, Edirne, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,8,26]]},"reference":[{"key":"R1-20260427","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1164\/rccm.201703-0548ST","article-title":"An Official American Thoracic Society\/European Society of Intensive Care Medicine\/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical ventilation in adult patients with acute respiratory distress syndrome","volume":"195","author":"Fan","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"R2-20260427","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1016\/j.chest.2022.01.052","article-title":"Setting and titrating positive end-expiratory pressure","volume":"161","author":"Millington","year":"2022","journal-title":"Chest"},{"key":"R3-20260427","doi-asserted-by":"crossref","first-page":"2050","DOI":"10.1097\/CCM.0b013e31828e9084","article-title":"Selecting 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Res"},{"key":"R12-20260427","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1186\/s13054-021-03686-3","article-title":"Personalized mechanical ventilation in acute respiratory distress syndrome","volume":"25","author":"Pelosi","year":"2021","journal-title":"Crit Care"},{"key":"R13-20260427","first-page":"1115","article-title":"Effects of rib cage or abdominal restriction on lung mechanics","volume":"51","author":"Scheidt","year":"1981","journal-title":"J Appl Physiol Respir Environ Exerc Physiol"},{"key":"R14-20260427","first-page":"S85","article-title":"Partitioning of respiratory mechanics in intra-abdominal hypertension","volume":"29","author":"Malbrain","year":"2003","journal-title":"Intensive Care Med"},{"key":"R15-20260427","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1056\/NEJM200005043421801","article-title":"Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress 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