II. Indications
- Pulmonary condition with widespread alveolar collapse
-
Adult Respiratory Distress Syndrome (ARDS)
- PEEP increases Lung Compliance
- PEEP decreases intrapulmonary shunting
- Increases PO2 and allows lower FIO2 below 60%
- May increase dead space ventilation
- Overdistends normal lung
-
Pulmonary Edema
- PEEP allows decrease in FIO2 below 60%
- PEEP may increase extravascular lung water
III. Indications: Disproved uses of PEEP
- Localized Lung Disease (e.g. Lobar Pneumonia)
- PEEP may worsen Hypoxemia
- Overdistends normal lung
- Directs Blood Flow to diseased lung
- PEEP not recommended
- Unless selectively applied to diseased lung
- PEEP may worsen Hypoxemia
- Prophylactic PEEP
- PEEP does not reduce ARDS Incidence
- Routine PEEP
- PEEP does not appear indiscriminately beneficial
- Mediastinal Bleeding
- PEEP does not protect against mediastinal bleeding
IV. Physiology
- PEEP maintains small end-expiratory pressure
- Helps to prevent alveolar collapse
- Promotes alveolar-capillary gas exchange
- Increases lung function parameters
- Increases Functional Residual Capacity (FRC)
- Increases Cardiac Output with low airway pressures
- May result in increased Oxygen Delivery
V. Dosing: PEEP Table (ARDSNet, Low PEEP Version)
- Usual PEEP setting: 5 to 10 cm H2O
-
ARDS-NET PEEP Adjustment based on FIO2 for mechanically ventilated patients
- PEEP Levels >15 cm H2O are rarely required and are associated with complications (Barotrauma)
- Strategy listed here correlates to the ARDSNet lower PEEP version
- FIO2: 0.3
- PEEP: 5 cm H2O
- FIO2: 0.4
- PEEP: 5 to 8 cm H2O
- FIO2: 0.5
- PEEP: 8 to 10 cm H2O
- FIO2: 0.6
- PEEP: 10 cm H2O
- FIO2: 0.7
- PEEP: 10 to 14 cm H2O
- FIO2: 0.8
- PEEP: 14 cm H2O
- FIO2: 0.9
- PEEP: 14 to 18 cm H2O
- FIO2: 1.0
- PEEP: 18 to 24 cm H2O
- PEEP Levels >15 cm H2O are rarely required and are associated with complications (Barotrauma)
VI. Complications
- Decreased Cardiac Output
- Associated with higher airway pressures
- Associated with decreased ventricular filling
- Barotrauma
- Fluid Retention
- Intracranial Hypertension
VII. References
- Marino (1991) ICU Book, Lea & Febiger, p. 375-9
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Related Studies
| Concepts | Therapeutic or Preventive Procedure (T061) |
| MSH | D011175 |
| English | PEEP, Positive end expiratory pressure, Positive End-Expiratory Pressure, positive end expiratory pressure (PEEP), positive end-expiratory pressure, positive end expiratory pressure, peeps, peep, positive pressure breathing, End-Expiratory Pressure, Positive, Pressure, Positive End-Expiratory, Pressures, Positive End-Expiratory, End-Expiratory Pressures, Positive, Positive End Expiratory Pressure, Positive End-Expiratory Pressures, Positive end-expiratory pressure |
| Italian | Pressione positiva al termine dell'espirazione, Pressione positiva tele-espiratoria, Pressione positiva di fine espirazione |
| Dutch | PEEP, positive end-expiratory pressure |
| French | PEP (pression expiratoire positive), Pression de fin d'expiration positive |
| German | PEEP, Positiver endexspiratorischer Druck, positiver endexpiratorischer Druck |
| Portuguese | PEEP, Pressão Positiva Expiratória Final, Pressão expiratória final positiva |
| Spanish | PTEP, Presión Positiva Espiratoria Final, Presión tele-espiratoria positiva |
| Japanese | 終末呼気陽圧, ＰＥＥＰ, ｼｭｳﾏﾂｺｷﾖｳｱﾂ, PEEP |
| Czech | PEEP, Pozitivní tlak na konci expiria |
| Hungarian | PEEP, Pozitív kilégzésvégi nyomás |
| Norwegian | PEEP, Positivt endeekspiratorisk trykk |
