Auto-PEEP What is Auto-PEEP? • Progressive air trapping & dynamic hyperinflation → ↑Palv at end expiration • Auto-PEEP = intrinsic PEEP When does Auto-PEEP happen? • Auto-PEEP happens when there is incomplete exhalation before the next inspiration • Commonly due to expiratory airway resistance (e.g. asthma), or high VE How do we detect Auto-PEEP? • Suspect when flow on ventilator does not go back to O before next breath • An expiratory hold maneuver on the ventilator allows us to quantify auto-PEEP Why do we care about auto-PEEP? • Auto-PEEP → ↑ intrathoracic pressure → barotrauma and decreased venous return → hypotension. Also, increased effort to trigger a breath How do we fix auto-PEEP? • Decrease airway resistance (e.g. bronchodilators) • Increase expiratory time (Tflow rate = decrease I:E ratio, decrease RR) • Decrease overall minute ventilation • In acute scenario (e.g. hypotension) disconnect patient from ventilator By @PulmPEEPs #AutoPEEP #PEEP #pulmonary #diagnosis #management #criticalcare #MechanicalVentilation
