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
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.
