UMEM Educational Pearls

Category: Critical Care

Title: Auto-PEEP

Keywords: auto-peep, mechanical ventilation (PubMed Search)

Posted: 11/4/2008 by Mike Winters, MD (Updated: 8/12/2020)
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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

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.