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Auto-PEEP refers to the positive pressure within alveoli at end-expiration that has not been generated by a ventilator. A) Status asthmaticus, Acute Exacerbation of COPD are examples of auto-pEEP in non ventilated patients.
Auto-PEEP refers to the positive pressure within alveoli at end-expiration that has not been generated by a ventilator. A) Status asthmaticus, Acute Exacerbation of COPD are examples of auto-pEEP in non ventilated patients.
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Auto-PEEP refers to the positive pressure within alveoli at end-expiration that has not been generated by a ventilator. A) Status asthmaticus, Acute Exacerbation of COPD are examples of auto-pEEP in non ventilated patients.
Hak Cipta:
Attribution Non-Commercial (BY-NC)
Format Tersedia
Unduh sebagai PDF, TXT atau baca online dari Scribd
DR. VISHWAJITH S M Resident in ICU. Sri B.M.J Hospital, Bangalore. Introduction PEEP – Positive End Expiratory Pressure is the pressure in the alveolus at the end of the expiration.
There are 2 kinds of PEEP – iPEEP (intrinsic)
and ePEEP (extrinsic). Definition of Auto PEEP Auto-PEEP (also known as “intrinsic” PEEP) refers to the positive pressure within alveoli at end-expiration that has not been generated by a ventilator. Also called as intrinsic PEEP, Breath stacking, occult PEEP. Where can we see it? a) Status asthmaticus, Acute Exacerbation of COPD are examples of auto PEEP in non ventilated patients.
b) Inadequate expiratory time on mechanically
ventilated patients. Why does it occur? In AE of COPD and Status asthmaticus: Hyperventilation decreased expiratory time leading to initiation of inspiration before lung reaches the FRC. This leads to prgressive alveolar distension and positive pressure at the end of expiration (iPEEP). Why does it occur?
Also active airway smooth muscle contraction
causes dynamic hyperinflation and airtrapping resulting in Auto PEEP. Why does it occur? In mechanically ventilated patients: a. Inadequate expiratory time b. Unrecognized bronchospasm with high tidal volume, high minute ventilation(high RR), long inspiratory times (1:1or 2:1) c. Small Endotracheal tubes can increase PEEP. Recognise Auto PEEP Clinical
Increased work of breathing in a mechanically
ventilated patient. Use of accessory muscles of respiration. Presence of Pulsus paradoxus. Recognise Auto PEEP How to measure Auto PEEP In mechanically ventilated patients without spontaneous respiratory effort '' end-expiratory port occlusion method can be applied where the expiratory port is occluded near the time when the next inspiration is anticipated. Because the expiratory flow is blocked, pressure in the ventilatory tube equilibrates with alveolar pressure, allowing the level of PEEP to be measured on the ventilator manometer. How to measure Auto PEEP In ventilated patients with spontaneous respiratory effort esophageal balloon manometry can be applied. Esophageal pressure is in correlation with pleural pressures and hence the transmural distending pressure of the lung can be calculated. Complications of Auto PEEP Failure of the lung units to return to FRC at the end of expiration results in progressive increase in iPEEP and decreased oxygenation. Its also complicated by the fact that respiratory muscles work at a disadvantage operating in an unfavourable position on their length–tension curve. Positive alveolar pressure can impede venous return and hence impair circulatory function. Complications of Auto PEEP Continued mechanical ventilation in the presence of Auto PEEP may result in Pulmonary barotrauma in the form of pneumothorax, pneumo mediastinum, subcutaneous emphysema etc.. How to offset Auto PEEP Correct reversible parameters like using a larger ET tube, Bronchdilation, increasing expiratory time with decreasing tidal volume and respiratory rate. Apply ePEEP: Though it appears to be paradoxical ePEEP helps offsetting auto PEEP by splinting opening the airways and reducing airtrapping. The applied ePEEP should not exceed 85% of the measured auto PEEP. References 1. Fishman's Pulmonary Diseases and Disorders 4th edition.
2. Crofton and Douglas's Respiratory Diseases 5 th
edition.
3. Dr Azam's Notes in Anesthesiology 2 nd edition.