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Positive End-Expiratory Pressure
Aka: Positive End-Expiratory Pressure, PEEP, PEEP Table
- See Also
- Non-Invasive Positive Pressure Ventilation
- Mechanical Ventilation
- Bilevel Positive Airway Pressure (BIPAP)
- Continuous Positive Airways Pressure (CPAP)
- Acute Respiratory Failure
- High Humidity High Flow Nasal Oxygen (HHFNC)
- 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
- 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
- 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
- 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
- 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
- Complications
- Decreased Cardiac Output
- Associated with higher airway pressures
- Associated with decreased ventricular filling
- Barotrauma
- Fluid Retention
- Intracranial Hypertension
- References
- Marino (1991) ICU Book, Lea & Febiger, p. 375-9