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Mechanically ventilated patients can develop a condition in which air becomes trapped within the alveoli at end-expiration; this is called auto-PEEP.
Auto-peep has several adverse effects:
- Barotrauma from positive pressure trapped within the alveoli
- Increased work of breathing
- Worsening pulmonary gas exchange
- Hemodynamic compromise secondary to increased intra-thoraic pressure
Auto-PEEP classically occurs in intubated patients with asthma or emphysema, but it may also occur in the absence of such disease. The risk of auto-PEEP is increased in patients with:
- Short expiration times (i.e., inadequate time for the evacuation of alveolar air at end-expiration)
- Bronchoconstriction
- Plugging of the bronchi (e.g., mucus or foreign body) creating a one-way valve and air-trapping
Auto-PEEP may be treated by:
- Reducing tidal volume
- Reducing the respiratory rate
- Decreasing inspiratory time
- Increasing PEEP
Patients may need to be heavily sedated to accomplish the above ventilator maneuvers.
References
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