What is the risk of pneumothorax with high levels of PEEP?

High levels of positive end-expiratory pressure (PEEP) can indeed pose a risk for pneumothorax, particularly when used excessively. The use of PEEP is essential in managing patients with respiratory distress, as it helps recruit collapsed alveoli and improve gas exchange. However, the risk of pneumothorax increases with higher levels of PEEP due to the increased intrathoracic pressure that can compromise the integrity of the pleural space.

While the usage of PEEP can lead to complications, the risk of pneumothorax does not become significant until PEEP levels exceed 30 cm H2O. At that level, the increased pressure may lead to over-distension of alveoli and potential rupture, leading to pneumothorax. Below that threshold, the risk remains relatively low unless other factors, such as lung pathology or mechanical ventilation settings, contribute.

Understanding this threshold allows clinicians to balance the benefits of improving oxygenation and lung recruitment with the risk of potential complications. This context underscores why the assertion regarding pneumothorax risk at high levels of PEEP holds true primarily for values significantly exceeding typical therapeutic ranges.