A 65-year-old female with a history of severe COPD and coron…
A 65-year-old female with a history of severe COPD and coronary artery disease is intubated for severe acute respiratory distress syndrome (ARDS) in the setting of pneumonia. Despite ventilation with 6 mL/kg tidal volumes and neuromuscular blockade, PaO2:FiO2 remains 85 on FiO2 100%. PEEP is increased from 5 to 10 cm H2O, and mean arterial pressure subsequently decreases from 65 to 45. In what setting is increased PEEP least likely to improve oxygenation and hemodynamics?