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PEEP in the Intubated Obese Patient
- Obesity has numerous adverse effects on the respiratory system, most notably a reduction in lung volumes.
- The reduction in lung volumes (i.e., FRC) often result in airway closure and atelectasis.
- The application of PEEP in the mechanically ventilated patient helps maintain alveolar patency by preventing derecruitment.
- Importantly, the typical initial PEEP setting of 5 cm H2O is insufficient for many ventilated obese patients.
- Pearl: In the ventilated obese patient start with an initial PEEP of 10-15 cm H2O.
References
De Jong A, et al. How to ventilate obese patients in the ICU. Intensive Care Med. 2020; 46:2423-35.