Positive end-expiratory pressure (PEEP)
- Rommel Sagana, MD
Rommel Sagana, MD
- Assistant Professor, Division of Pulmonary and Critical Care Medicine
- University of Michigan Medical Center
- Robert C Hyzy, MD
Robert C Hyzy, MD
- Professor of Medicine
- University of Michigan Medical Center
Positive end-expiratory pressure (PEEP) is used therapeutically during mechanical ventilation (extrinsic PEEP). It can also be a complication of incomplete expiration and airtrapping (intrinsic PEEP).
Clinical aspects of extrinsic and intrinsic and PEEP are discussed in this topic review. High levels of PEEP that have been investigated in patients with acute respiratory distress syndrome as well as the application of PEEP in patients with dynamic hyperinflation from asthma and chronic obstructive pulmonary disease are described separately. (See "Mechanical ventilation of adults in acute respiratory distress syndrome", section on 'High PEEP' and "Invasive mechanical ventilation in acute respiratory failure complicating chronic obstructive pulmonary disease", section on 'Dynamic hyperinflation' and "Invasive mechanical ventilation in adults with acute exacerbations of asthma", section on 'Adding extrinsic PEEP to offset intrinsic PEEP'.)
Positive end-expiratory pressure (PEEP) is the alveolar pressure above atmospheric pressure that exists at the end of expiration. There are two types of PEEP:
●Extrinsic PEEP – PEEP that is provided by a mechanical ventilator is referred to as applied PEEP
●Intrinsic PEEP – PEEP that is secondary to incomplete expiration is referred to as intrinsic PEEP or auto-PEEP
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- APPLIED (EXTRINSIC) PEEP
- - Routine mechanical ventilation
- - Acute respiratory distress syndrome
- - Patients with auto-peep
- - Cardiogenic pulmonary edema
- - Intraoperative patients
- - Postoperative patients
- - Other
- - Intracranial disease
- - Focal lung disease
- - Hypotension
- - Hyperinflation without flow limitation
- - Prone patients
- AUTO (INTRINSIC) PEEP
- - High minute ventilation
- - Expiratory flow limitation
- - Expiratory resistance
- Potential sequelae
- - Applied PEEP
- SUMMARY AND RECOMMENDATIONS
- Applied PEEP