Episode URL
https://ventil8ingPEEPS.podbean.com/e/ventil8ing-peeps-optimal-peep/
The transcript for episode 1 of Ventil8ing PEEPS.
Welcome to Ventil8ing PEEPS where I, your host Wendy Ayers, discusses everything related to Respiratory Therapy!
You can follow me and find this episode on https://ventil8ingpeeps.podbean.com/
Today is episode one, and all about optimal PEEP, what it is, and how to find it!
Let's start PEEPing!
Content
Let me start by saying, optimal PEEP isn’t hard to find.
First, we need to understand what extrinsic PEEP is. It’s a positive pressure above atmospheric pressure that RTs add to a patient’s ventilator settings. We call Atmospheric pressure baseline pressure. Baseline pressure is where every breath begins and ends. Adding extrinsic PEEP increases the baseline pressure.
So, what is the purpose of extrinsic PEEP? It prevents the alveoli from collapsing, it improves oxygenation and FRC, and it increases the alveolar surface.
There is more to extrinsic PEEP than pushing a button on the ventilator. It is important to focus on optimal PEEP. If we place a patient on too little PEEP, it will cause atelectasis, decrease lung compliance, and increase driving pressures. This could potentially cause barotrauma from the alveoli closing during exhalation (may also be referred to as derecruitment) and popping open during a positive pressure breath.
If we place a patient on too much PEEP, it will cause alveolar overdistension and increase intrathoracic pressures. The effect on the cardiac system may be a decreased venous return and cardiac output. Overdistension of alveoli compresses the capillary vessels around the alveoli reducing blood flow to that area which may affect gas exchange.
This brings us to Optimal PEEP, which means oxygenation is maximized without cardiac compromise, minimized atelectasis, and over-distention.
There are multiple ways to find optimal PEEP. I am going to discuss the 2 that I believe are the easiest. 1. Calculating lung compliance and viewing PaO2, or 2. you can use plateau pressure and driving pressure.
What are desired maximum values? Plateau pressure should be less than 30 cmH20 with a driving pressure of less than 15 cmH20.
Grab a piece of paper and make 3 columns.
Method #1
PEEP | Lung Compliance | PaO2 |
10 | 32 | 65 |
12 | 38 | 71 |
14 | 35 | 78 |
Method #2
Driving Pressure = Plateau Pressure - PEEP
PEEP | Plateau Pressure | Driving Pressure |
10 | 20 | 10 |
12 | 26 | 14 |
14 | 30 | 16 |
Outro
Thank you for tuning in to episode one, Optimal PEEP, what it is, and how to find it. Find episode one of Ventil8ing PEEPS at https://ventil8ingpeeps.podbean.com/.
Transcripts are available at www.wendyfa.blogspot.com. See you next time when I discuss low V/Q mismatch and high V/Q mismatch. Drop topic suggestions on Facebook, @Ventil8ingPEEPS.
Episode URL
https://ventil8ingPEEPS.podbean.com/e/ventil8ing-peeps-optimal-peep/
Share URL
https://www.podbean.com/eas/pb-jnc3b-13f3767
@Ventil8ingPEEPS
Reference
Cairo, J. M. (2020). Pilbeam’s Mechanical Ventilation: Physiological and Clinical
Applications (7th ed.). Elsevier Inc.
