Increased level of PEEP due to insufficient time for expiration, leading to 'air trapping', CO2 retention, increased airway pressures and increased FRC. Seen in pathological conditions of increased airflow resistance (e.g. asthma, emphysema) and when insufficient expiratory time is set on the ventilator. Used clinically in inverse ratio ventilation to increase oxygenation and decrease peak airway pressures. High levels of PEEPi can, however, slow weaning by an increased work of breathing; use of extrinsic PEEP may overcome this. PEEPi can be measured by temporarily occluding the expiratory outlet of ventilator at end-expiration for a few seconds to allow equilibration of pressure between upper and lower airway and then reading the ventilator pressure gauge (or print-out).
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