Optimising positive end-expiratory pressure in acute respiratory distress syndrome: from optimal value to dynamic stability zone. Comment on Br J Anaesth 2026; 136: 1472–81

The article comments on the approach to positive end-expiratory pressure (PEEP) titration optimization in acute respiratory distress syndrome (ARDS). The authors highlight the limitations of titration based solely on oxygenation values and emphasize the benefits of integrating respiratory mechanics, esophageal pressure, computed tomography, and other diagnostic methods. They stress that individualized PEEP should balance alveolar recruitment against overdistension. A key proposal is that PEEP should not be considered a single fixed value, but rather a patient-specific range that needs to be regularly reassessed as ARDS evolves and with changes in patient positioning, supportive systems, and cardiopulmonary tolerance.