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Auto-PEEP in the non-COPD patient
- In previous pearls we have discussed the concept of auto-peep in patients with expiratory flow limitation (asthma and COPD)
- Unexpected auto-peep can also occur in up to 35% of patients without asthma or COPD
- In these patients, auto-PEEP typically occurs with high minute ventilations (> 20 L/min) with shortened exhalation times or if exhalation is blocked (blocked ETT, exhalation valve, or PEEP valve)
- Recall that auto-PEEP increases the work of breathing, worsens gas exchange, and can cause hemodynamic compromise
- Treatment of auto-PEEP can be as follows:
- Change ventilator settings
- increase expiratory time
- decrease respiratory rate
- decrease tidal volume
- Reduce ventilatory demand
- reduce anxiety, pain, fever with sedatives
- Reduce flow resistance
- large-bore ETT
- frequent suctioning
- Apply external PEEP
- Change ventilator settings
References
Mughal MM, Minai OA, Culver DA, et al. Auto-positive end-expiratory pressure: mechanisms and treatment. Clev Clin J Med 2005;72:801-9.