PEEP Flashcards
when should PEEP be used for adults
a) Do not attach PEEP during cardiac arrest.
b) Apply PEEP set to 5 cmH2O if the patient has TBI.
c) Apply PEEP set to 10 cmH2O for all other conditions.
when should PEEP be used on kids
a) Do not attach PEEP during cardiac arrest.
b) Apply PEEP set to 5 cmH2O for all other conditions.
when should peep be used for neonates
a) Apply PEEP set to 5 cmH2O, including during cardiac arrest.
For an adult with cardiogenic pulmonary oedema if CPAP is indicated but unavailable:
a) Apply PEEP set to 10 cmH2O. Focus on ensuring a tight seal with the mask and do not assist the patient’s breathing unless it is ineffective.
b) Increase the PEEP to 15 cmH2O if the patient is not improving.
* Use PEEP with caution if:
ū Ventilation is occurring via an ETT or LMA and the patient has signs of shock.
ū PEEP is being applied using a manual ventilation bag and mask, and the patient has an altered level of consciousness or vomiting.
PEEP is not applied to adults and children during CPR because
an increase in intrathoracic pressure reduces the blood flow achieved during CPR. If ROSC is achieved it is appropriate to apply PEEP, but this is not an immediate priority.
The reduction in cardiac output may be significant if PEEP is combined with positive pressure ventilation in patients with:
ū
A clinical condition reducing right ventricular filling, such as hypovolaemia. A clinical condition increasing right ventricular afterload, such as pulmonary embolism.
PEEP improves oxygenation, improves ventilation and reduces the workload of breathing, via the following physiological effects:
ū The expiratory pressure assists small and medium sized airways to remain open during expiration, preventing lung collapse. Once collapsed, significant additional pressures are required to re-expand them.
ū The positive pressure in the thoracic cavity reduces the preload (filling) of the right ventricle by reducing venous return to the heart.
ū The positive pressure in the thoracic cavity increases the afterload of the right ventricle and reduces venous return to the heart. This reduces blood flow through lung vessels, reducing the amount of fluid entering the lungs.
ū The expiratory pressure increases the amount of air remaining in the lungs at the end of expiration, (also called the functional residual capacity) and this causes the lungs to be more expanded. From this more expanded resting position, less work is required to inspire as a result of the non-linear compliance of the lungs, particularly when the lungs are wet.
* PEEP has similar physiological effects to CPAP, but does not provide additional inspiratory pressure during inspiration.
PEEP is not applied to adults and children during CPR because
increase in intrathoracic pressure reduces the blood flow achieved during CPR. If ROSC is achieved it is appropriate to apply PEEP, but this is not an immediate priority.
