special procedure what is peep ? positive end expiratory pressure where does peep have a positive...
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Special Procedure
What is PEEP ?
Positive End Expiratory Pressure
Where does PEEP have a positive effect?
Increased alveolar recruitment
What could be compromised with PEEP? Poor venous return Negative influence on heart
What is PEEPi ?
Intrinsic PEEP
A measurement, in pressure, of trapped volume in lungs
High PEEPi is a result of patient illness and patient/ventilator interaction
Trapped Volume During Mandatory Ventilation
Paw
t
Insp.- und Exp.- valve closed Exp. valve opened
t
Flow
PEEP
Vtrap
mes. time 1 mes. time 2
Intrinsic PEEP
Paw
t
Insp.- und Exp.- valve closed Exp. valve opened
t
Flow
PEEP
Vtrap
mes. time 1 mes. time 2
Intrinsic PEEP
Time (I : E ratio) Insp. time - must be adequate for delivery of desired VTI
Exp. time - must be long enough to eliminate VTE
Insufficient expiratory time means trapped volume
t
PEEPi = Auto PEEP = Alveolar PEEP
Lung status information available in every mode
Auto stop of measurements if pressure increases (mes. time 1) or flow becomes zero (mes. time 2)
Maximum measuring times for paediatric and adults
PEEPi adult max. 3 spaediatric max. 1.5 s
VTrap adult max. 7 spaediatric max. 3.5 s
Improved monitoring of inverse ratio ventilation (IRV)
Paw
t0
mes. time 1 mes. time 2
PEEPi Vtrap
PEEPi
tota
l PE
EP
ext
..
PE
EP
PEEP
Paw
t0
mes. time 1 mes. time 2
PEEPi Vtrap
PEEPi
tota
l PE
EP
ext
..
PE
EP
PEEP
PEEPi
Heart and Lung
poor Compliance contributes to poor gas exchange
pressure is in the lungs
pressure is in the heart
They work against each other.
PEEPi increases pressure against the heart.
VTrap P
P
Where Does Measurement of PEEPi Take Us?
Safer ventilation
Improved alveolar recruitment
Improved ventilation comfort for asthmatics and COPD patients