Intensive Care Med

Apuntes

Intensive Care Med https://doi.org/10.1007/s00134-025-08111-9 NARRATIVE REVIEW Pathophysiology and clinical applications of PEEP in acute brain injury Ida Giorgia Iavarone 1,2 , Patricia Rieken Macedo Rocco 3 , Domenico Luca Grieco 4,5 , Tommaso Rosà 4,5 , Mariangela Pellegrini 6 , Rafael Badenes 7 , Robert D. Stevens 8 , Karim Asehnoune 9,10 , Chiara Robba 1,2 , Luigi Camporota 11,12* and Antoine Roquilly 9,10* © 2025 Springer-Verlag GmbH Germany, part of Springer Nature Abstract Mechanical ventilation is a life-sustaining treatment needed in patients with acute brain injury to maintain airway per- meability, optimize gas exchange, and prevent secondary brain damage. Positive end-expiratory pressure (PEEP), a key component of mechanical ventilation, helps prevent atelectasis, improve oxygenation, and stabilize alveolar recruit- ment, offering potential benefits in terms of lung protection. However, neurological tolerance of PEEP can be poor in brain-injured patients. The variability in lung and chest-wall elastance, lung recruitability, cardiac function, and fluid status, as well as the integrity of cerebral autoregulation, further complicates the recommendations for the safe rang...