Special Procedure

What is PEEP ?

Positive End Expiratory Pressure

Where does PEEP have a positive effect?

Increased alveolar recruitment

What could be compromised with PEEP? Poor venous return Negative influence on heart

What is PEEPi ?

Intrinsic PEEP

A measurement, in pressure, of trapped volume in lungs

High PEEPi is a result of patient illness and patient/ventilator interaction

Trapped Volume During Mandatory Ventilation

Paw

t

Insp.- und Exp.- valve closed Exp. valve opened

t

Flow

PEEP

Vtrap

mes. time 1 mes. time 2

Intrinsic PEEP

Paw

t

Insp.- und Exp.- valve closed Exp. valve opened

t

Flow

PEEP

Vtrap

mes. time 1 mes. time 2

Intrinsic PEEP

Time (I : E ratio) Insp. time - must be adequate for delivery of desired VTI

Exp. time - must be long enough to eliminate VTE

Insufficient expiratory time means trapped volume

t

PEEPi = Auto PEEP = Alveolar PEEP

Lung status information available in every mode

Auto stop of measurements if pressure increases (mes. time 1) or flow becomes zero (mes. time 2)

Maximum measuring times for paediatric and adults

PEEPi adult max. 3 spaediatric max. 1.5 s

VTrap adult max. 7 spaediatric max. 3.5 s

Improved monitoring of inverse ratio ventilation (IRV)

Paw

t0

mes. time 1 mes. time 2

PEEPi Vtrap

PEEPi

tota

l PE

EP

ext

..

PE

EP

PEEP

Paw

t0

mes. time 1 mes. time 2

PEEPi Vtrap

PEEPi

tota

l PE

EP

ext

..

PE

EP

PEEP

PEEPi

Heart and Lung

poor Compliance contributes to poor gas exchange

pressure is in the lungs

pressure is in the heart

They work against each other.

PEEPi increases pressure against the heart.

VTrap P

P

Where Does Measurement of PEEPi Take Us?

Safer ventilation

Improved alveolar recruitment

Improved ventilation comfort for asthmatics and COPD patients