Peep Cpap and autoPEEP

Passive expiratory airflow dynamics and the necessity for long expiratory times have lead to the concept of 'auto-PEEP' and to consideration of the potential gains that might be achieved by the addition of PEEP or continuous positive airways pressure (CPAP). Although there is anecdotal evidence supporting the use of PEEP and CPAP, undesirable effects on the cardiovascular system, particularly in a volume-depleted patient, represent a significant hazard. If one of the major goals is to avoid overdistention of the alveoli and minimize the effects on the cardiovascular system, PEEP offers little or no benefit during controlled mechanical ventilation of asthma. If PEEP is required for purposes of oxygenation, its effect on lung volume must be assessed and compensated for by reductions in VT or respiratory rate. In general, improved oxygenation, together with relief of mucus plugging, will follow reversal of bronchospasm.

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