HWN Suggests

Under Pressure: Positive End Expiratory Pressure (PEEP)

PEEP is a complex and vital component of mechanical ventilation, with multifaceted effects on respiratory mechanics, gas exchange, hemodynamics, and even neurodynamics. Its application requires a nuanced understanding of underlying pathophysiology, continuous monitoring with advanced tools, and individualized titration to optimize patient outcomes. The integration of PEEP into a comprehensive respiratory care strategy exemplifies the complexity and precision required in critical care medicine.

read full article

Featured

 Mechanical Ventilation- PEEP (Positive End Expiratory Pressure

What is PEEP, why do we use it and what are the pros and cons.

 PEEP PEEP PEEP

Ventilator management can be one of the more intimidating aspects of caring for critically ill patients both in the ED and in the prehospital setting. One of the takeaways from the video should be the hemodynamic changes that occur with the application of PEEP.

Articles of Interest

COVID-19: “To PEEP, or not to PEEP”?

PEEP is positive end expiratory pressure. “To PEEP, or not to PEEP”, and how much, is another area of controversy in the management of COVID-19. Is PEEP dangerous in COVID-19 patients? Is it beneficial? The answer is “Yes” – to both questions – just like it is for any other acute respiratory distress syndrome (ARDS) patient…

PEEP: A Tool for Any EMS Provider

Positive End Expiratory Pressure, or PEEP, is getting a lot of attention lately. First described in 1938 as an addition to mechanical ventilation that improved oxygenation in acute pulmonary edema, asphyxia and sepsis, the hemodynamic effects of PEEP prevented its widespread use until the 1960s. By 1970, PEEP had gained traction in treating premature neonates with respiratory distress and adults with acute respiratory distress syndrome (ARDS). Today, a growing body of literature suggests that PEEP benefits a wide variety of patients with respiratory distress and might well be useful any time you need to assist ventilations.

Positive End-Expiratory Pressure. When More May Not Be Better

PEEP has an important role in the management of patients with hypoxemic respiratory failure, especially in patients with high shunt fractions who are less responsive to increases in FiO2, but it may also have adverse effects. Although PEEP improves oxygenation in diffuse lung disease, it can paradoxically worsen ventilation–perfusion ratios and gas exchange in patients with more focal processes. In addition, high levels of PEEP can decrease cardiac output and tissue oxygen delivery with subsequent decreases in mixed and central venous oxygen content that contribute to impaired arterial oxygenation in patients with increased shunt fractions.

Resources

Anesthesia Key

Adding positive end-expiratory pressure (PEEP) can help maintain patency of collapsed lung units or further distend those that are already patent. The former action usually is beneficial, whereas the latter may cause alveolar overdistention. Both effects may occur simultaneously in different lung regions at the same level of PEEP.

Life in the Fastlane

Positive End-Expiratory Pressure (PEEP) is the maintenance of positive pressure (above atmospheric) at the airway opening at the end of expiration. PEEP acts to distend distal alveoli, assuming there is no airway obstruction.