• Reduced cardiac output. May need additional fluid loading or even inotropes. This should generally be avoided unless higher PEEP is necessary to maintain adequate arterial oxygenation. Caution should be exercised in patients with myocardial ischaemia.

• Increased airway pressure (and potential risk of ventilator trauma).

• Overinflation leading to air trapping and raised PaCO2. Use with caution in patients with chronic airflow limitation or asthma. In pressure- controlled ventilation overdistension is suggested when an increase in PEEP produces a significant fall in tidal volume.

• High levels will decrease venous return, raise intracranial pressure and increase hepatic congestion.

• PEEP may change the area of lung in which a pulmonary artery catheter tip is positioned from West Zone III to non-Zone III. This is suggested by a rise in wedge pressure of at least half the increase in PEEP and requires resiting of the PA catheter.

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