A recruitment maneuver (RM) is being performed on a patient receiving mechanical ventilation with PCV. During the maneuver the mode remains in PCV, rate = 10/min, I:E = 1:2, and PIP = 35 cm H2O

The following information is documented during the RM:

Time 0800 0805 0810 0815 0820 0825 0830 0835 0840
PEEP 10 15 20 25 30 25 20 15 10
Static com-pliance 24 29 34 25 22 27 31 36 32
BP 126/68 124/66 118/58 110/55 106/58 112/60 118/62 115/60 117/62
HR 108 108 105 100 100 102 105 106 105

After the RM, the lungs are reinflated. At what level should the PEEP be set for this patient?
a. 12 cm H2O
b. 17 cm H2O
c. 22 cm H2O
d. 27 cm H2O

ANS: A
This is the PCV with increased PEEP recruitment technique. The point of decreased compliance on deflation represents the UIPd of the lungs. Once the lungs have been reinflated to allow reo-pening of lung units, PEEP is decreased until a pressure 2 cm H2O above the UIPd is obtained. For this patient, that would be 12 cm H2O.