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PEEP in the Ventilated COPD Patient?
- Patients with acute respiratory failure secondary to COPD often have dynamic hyperinflation and intrinsic PEEP (PEEPi).
- Both dynamic hyperinflation and PEEPi adversely effect pulmonary mechanics, markedly increase the work of breathing, impair respiratory muscle function, and can result in hemodynamic compromise.
- It has traditionally been felt that the application of external PEEP in the intubated COPD patient may worsen hyperinflation.
- Importantly, external PEEP has been shown to improve ventilator synchrony and decrease the work of breathing.
- PEEPi is measured using an end-expiratory hold maneuver in a passive, relaxed patient.
- External PEEP can then be set to approximately 70% of PEEPi, followed by frequent monitoring of plateau pressures in a volume-cycled ventilation mode.
References
Jubran A. Setting positive end-expiratory pressure in the severely obstructive patient. Curr Opin Crit Care. 2024; 30:89-96.