Why Is High PEEP Bad?

What happens when you decrease peep?

This reduction in lung volume decreases the surface area available for gas exchange and results in intrapulmonary shunting (unoxygenated blood returning to the left side of the heart)..

What happens if PEEP is too high?

Nurses who look after ventilated patients should be aware that high PEEP can lead to barotrauma and a drop in cardiac output- thus protocols should be in place to counter these complications.

How does high PEEP affect blood pressure?

Second, PEEP increases intrathoracic pressure, particularly when used in focal processes. This decreases venous return and cardiac output with subsequent adverse effects on systemic blood pressure and tissue oxygen delivery.

Can high PEEP cause pneumothorax?

High PEEP had been reported to be associated with pneumothorax[1] but several studies have found no such relationship[15,17,23,28,37]. Increased pressure is not enough by itself to produce alveolar rupture, with some studies demonstrating that pneumothorax is related to high tidal volume[37].

What should peep be set at?

Applied (extrinsic) PEEP is usually one of the first ventilator settings chosen when mechanical ventilation is initiated. It is set directly on the ventilator. A small amount of applied PEEP (4 to 5 cmH2O) is used in most mechanically ventilated patients to mitigate end-expiratory alveolar collapse.

Can high PEEP cause bradycardia?

The subsequent increase in heart rate with increasing PEEP demonstrated a clear causal relationship between the PEEP change and the bradycardia.

What is the difference between PIP and PEEP?

The difference between the peak inspiratory pressure (PIP) and Pplat is determined by resistance and flow. The difference between Pplat and PEEP is determined by tidal volume and respiratory system compliance. … The difference between PEEP set and the pressure measured during this maneuver is the amount of auto-PEEP.

What are normal ventilator settings?

Initial settings for ventilation may be summarized as follows:Assist-control mode.Tidal volume set depending on lung status – Normal = 12 mL/kg ideal body weight; COPD = 10 mL/kg ideal body weight; ARDS = 6-8 mL/kg ideal body weight.Rate of 10-12 breaths per minute.FIO2 of 100%Sighs rarely needed.More items…•

What does high PEEP mean on ventilator?

high levels of positive end-expiratory pressureThe use of high levels of positive end-expiratory pressure (PEEP) is part of the strategy aimed at reducing ventilator-induced lung injury. PEEP is a mechanical manoeuvre that exerts a positive pressure in the lung and is used primarily to correct the hypoxaemia caused by alveolar hypoventilation.

What causes high peep?

Acute causes of elevated elastic work are pneumothorax, tension pneumothorax, evolving pneumonia, pulmonary edema, ARDS, and auto-PEEP caused by “breath stacking”. Plateau pressures greater than 30 cm/H20 have been implicated in ventilator-induced lung injury (VILI).

What is best peep?

Best or optimal PEEP will be defined as the PEEP below which PaO2 /FIO2 falls by at least 20%. If at least 20% PaO2 /FIO2 decrement is not obtained, then PEEP that will result in the highest PaO2 will be selected. Other Name: PEEP determined by Best oxygenation approach. Other: PEEP by Best Compliance.

How does peep affect the heart?

Except from the failing ventricle, PEEP usually decreases cardiac output, a well known fact since the classic studies of Cournand et al. … As heart rate usually does not change with PEEP [5], the entire fall in cardiac output is a consequence of a reduction in left ventricular (LV) stroke volume (SV).