High peak inspiratory pressure

Question 1

What is the definition of high peak inspiratory pressure?

Answer 1

Increase in peak inspiratory pressure >40 cm H20 or an elevation above an established baseline level

Question 2

Go through the etiology of high peak inspiratory pressure (there are 5)

Answer 2

Circuit or machine problem
ETT/supraglottic airway problem 
Decreased pulmonary compliance 
Drug induced problem 
Laryngospasm (if using supraglottic airway)

Question 3

What are examples of circuit/machine problems in high peak insp pressure?

Answer 3

Ventilator/bag switch in wrong position 
Stuck valve (inspiratory/expiratory APL)
PEEP valve accidentally placed in inspiratory limb

Question 4

Examples of ETT/supraglottic airway probem:

Answer 4

kinked tube
malpositioned supraglottic airway
endobronchial, esophageal intubation
foreign body/secretions plugging end of tube

Question 5

Examples of decreased pulmonary compliance

Answer 5

increased intra-abdominal pressure 
pulmonary aspiration 
bronchospasm
pulmonary edema 
PTX

Question 6

Examples of drug induced problem:

Answer 6

opioid induced chest wall rigidity
inadequate muscle relaxation
malignant hyperthermia

Question 7

How do you manage high peak inspiratory pressure? 
-what are you going to increase ?
verify what? 
switch to what? 
listen? 
Examine \_\_\_\_\_ 
Exclude: 
Disconnect what?

Answer 7

FIRST INCREASE FIO2 TO 100%
-verify the peak inspiratory pressure via manometer -don’t like this
-switch to manually using reservoir bag; assess pulmonary and circuit compliance
-auscultate! listen for symmetry, listen to stridorous sound of laryngospasm
-Examine trachea for deviation, check HR, BP
-Exclude ETT obstruction: pass catheter down ETT and apply suction to clear secretions , consider FOB
Disconnect circuit from ETT and squeeze-if PIP still high, get help to replace circuit and ventilate using BMV connected to 100%O2

Question 8

If you’ve done all of the steps to check for other causes of decreased chest compliance, then you can consider what?

Answer 8

MH
inadequate muscle relaxation
chest wall rigidity