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positive end-expiratory pressure (PEEP)

Indications: 1) diffuse disease 2) stiff lungs 3) inability to oxygenate on a non-toxic fiO2 (<50%) Contraindications: 1) no absolute contraindications 2) caution: intracranial abnormalities, lung disease, hypotension Mechanism of action: 1) opens up atelectic or fluid-filled alveoli 2) decreases ventilation-perfusion mismatch 3) improves oxygenation Complications: - PEEP can decrease cardiac output by decreasing preload, thus worsen oxygen delivery to tissues - auto PEEP Management: 1) Goals a) decrease FiO2 to non-toxic level (<50%) b) maintaining cardiac output 2) start 5 cm H20 3) > 5 cm of H20 is supraphysiologic 4) increase PEEP to decrease FiO2 [3] 5) indications for PEEP > 10 cm H20 not clear 6) adjust PEEP to maintain end-expiratory pressure < 30-35 cm H20 Also see: 1) permissive hypercapnia 2) auto PEEP 3) mechanical ventilation

Related

lung protective ventilation; low tidal volume ventilation; permissive hypercapnia mechanical ventilation (assisted ventilation)

Specific

auto-PEEP

General

alveolar pressure

References

  1. Jon D. Hirasuna, M.D. Clinical Professor of Medicine, UC Davis, Associate Clinical Professor of Medicine, UCSF, Sept 1997
  2. UpToDate 14.1 http://www.utdol.com
  3. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015