Positive end expiratory pressure 2 Adjusting PEEP

1. Measure blood gases and monitored haemodynamic variables.

2. If indicated, alter level of PEEP by 3-5cmH2O increments.

3. Re-measure gases and haemodynamic variables after 15-20min.

4. Consider further changes as necessary (including additional changes in PEEP, fluid challenge or vasoactive drugs).

A number of clinical trials have adjusted PEEP levels according to FIO2 requirements (see table). Although unlikely to constitute 'optimal PEEP' for an individual patient, this provides a useful approximation and starting point for further titration of therapy.

FIO2

0.3

0.4

0.4

0.5

0.5

0.6

0.7

0.7

0.7

0.8

0.9

0.9

0.9

1.0

PEEP

5

5

8

8

10

10

10

12

14

14

14

16

18

>18

(cmH2O)

0 0

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