Auto-PEEP indicated by the expiratory flow (red arrow) waveform not returning to baseline (pink arrow).
Auto-PEEP/Intrinsic PEEP (PEEP i)
PEEP-i is actually expiratory asynchrony however, it has a effect on patient triggering.
The pressure associated with the trapped volume acts as a inspiratory load to be over come by the patient during spontaneous breathing.
Increased Risks of PEEP-i
- Minute ventilation greater than 15 lpm.
- Airway resistance greater than 15 cmH2O.
- Evidence of expiratory flow obstruction (e.g. expiratory time constant > 1.2 seconds).
Strategies to Reduce PEEP i
- Increase expiratory time.
- decrease respiratory rate.
- Decrease expiratory resistance.
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