II. Indications

  1. Pulmonary condition with widespread alveolar collapse
  2. Adult Respiratory Distress Syndrome (ARDS)
    1. PEEP increases Lung Compliance
    2. PEEP decreases intrapulmonary shunting
    3. Increases PO2 and allows lower FIO2 below 60%
    4. May increase dead space ventilation
      1. Overdistends normal lung
  3. Pulmonary Edema
    1. PEEP allows decrease in FIO2 below 60%
    2. PEEP may increase extravascular lung water

III. Indications: Disproved uses of PEEP

  1. Localized Lung Disease (e.g. lobar Pneumonia)
    1. PEEP may worsen Hypoxemia
      1. Overdistends normal lung
      2. Directs Blood Flow to diseased lung
    2. PEEP not recommended
      1. Unless selectively applied to diseased lung
  2. Prophylactic PEEP
    1. PEEP does not reduce ARDS Incidence
  3. Routine PEEP
    1. PEEP does not appear indiscriminately beneficial
  4. Mediastinal Bleeding
    1. PEEP does not protect against mediastinal bleeding

IV. Physiology

  1. PEEP maintains small end-expiratory pressure
    1. Helps to prevent alveolar collapse
    2. Promotes alveolar-capillary gas exchange
  2. Increases lung function parameters
    1. Increases Functional Residual Capacity (FRC)
  3. Increases Cardiac Output with low airway pressures
    1. May result in increased Oxygen Delivery

V. Dosing: PEEP Table (ARDSNet, Low PEEP Version)

  1. Usual PEEP setting: 5 to 10 cm H2O
  2. ARDS-NET PEEP Adjustment based on FIO2 for mechanically ventilated patients
    1. PEEP Levels >15 cm H2O are rarely required and are associated with complications (Barotrauma)
      1. Strategy listed here correlates to the ARDSNet lower PEEP version
    2. FIO2: 0.3
      1. PEEP: 5 cm H2O
    3. FIO2: 0.4
      1. PEEP: 5 to 8 cm H2O
    4. FIO2: 0.5
      1. PEEP: 8 to 10 cm H2O
    5. FIO2: 0.6
      1. PEEP: 10 cm H2O
    6. FIO2: 0.7
      1. PEEP: 10 to 14 cm H2O
    7. FIO2: 0.8
      1. PEEP: 14 cm H2O
    8. FIO2: 0.9
      1. PEEP: 14 to 18 cm H2O
    9. FIO2: 1.0
      1. PEEP: 18 to 24 cm H2O

VI. Complications

  1. Decreased Cardiac Output
    1. Associated with higher airway pressures
    2. Associated with decreased ventricular filling
  2. Barotrauma
  3. Fluid Retention
  4. Intracranial Hypertension

VII. References

  1. Marino (1991) ICU Book, Lea & Febiger, p. 375-9

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Ontology: Positive End-Expiratory Pressure (C0032740)

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