PEEP

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Information about PEEP
Education

Published on June 24, 2009

Author: dranishjoshi

Source: authorstream.com

PEEP : PEEP Dr. ANISH JOSHI Definition : Definition Airway pressure > atmospheric pressure throughout the respiratory cycle The two terms PEEP and CPAP are used interchangeably, and lead to inappropriate confusion: they are the same thing, although CPAP is a more technically correct term. Slide 3: ARDS Pulmonary oedema* Prophylactic in all intubated patients* Intractable or refractory hypoxemia Surfactant conservation Indications Mechanism of action : Mechanism of action Advantages : Advantages ? FRC & TLC Alveolar recrutiment & prevention or derecruitment ? R ?L shunt resulting in ? in PaO2 Redistributes lung water from alveoli to interstitium Less VILI from shear forces ? work of breathing ? airway resistance, ? lung compliance upto a point later ? ? O2 delievery Disadvantages/ Cx : Disadvantages/ Cx ? C.O, ? SV, ? SVR, ? PVR – Hypotension, ? tissue perfusion Right heart strain, Berheim’s effect ? venous return, compression of heart by hyperinflated lungs ? O2 delievery, CO2 retention ? dead space VILI ? PaO2-Hyperinflation of compliant alveoli & ? of ventilation/perfusion abnormalities Disadvantages/ Cx contd. : Disadvantages/ Cx contd. Barotrauma – Pneumothorax, Pneumomediastinum, Interstitial emphysema ? intrathoracic pressure – Peak airway pressure ? in dead space & dead space/tidal volume ratio ? ICP ? renal & portal blood flow H2O retention ? Lymph drainage ? work of breathing Slide 9: How do I set PEEP for my patient ? Extent of lung injury Alveolar arterial O2 gradient or PaO2 /FiO2 gradient Chest wall compliance Higher PEEP for lower chest compliance & vice versa Optimal/Best PEEP : Optimal/Best PEEP Lowest level which maintains PaO2 > 60 mm Hg with FiO2 < 60 % Maximal O2 transport Optimal increase in the compliance Lowest shunt fraction Lowest Dead space/Tidal volume ratio & PaCO2 – EtCO2 NO significant differences in mortality and ICU stay between low to high PEEP ( 8.3-13.2) ( nejm 2004) PEEP VIDEO 1 : PEEP VIDEO 1 PEEP VIDEO 2 Slide 14: 0 PEEP 15 PEEP 15 PEEP , 3 breaths 15 PEEP , 5 breaths 0 PEEP , 1 breath 0 PEEP , 5 breaths 0 PEEP , 3 breaths Slide 16: THANK YOU ANISH JOSHI

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