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