PEEP Mechanism and Procedure in Ventilation

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Questions and Answers

What is the primary physiological benefit of PEEP in maintaining lung function?

PEEP helps keep small and medium-sized airways open during expiration, preventing lung collapse.

How does PEEP affect the right ventricle's preload during its application?

PEEP reduces the preload of the right ventricle by decreasing venous return to the heart.

What is the recommended PEEP setting for adults with conditions such as TBI or COPD?

The recommended PEEP setting for adults with TBI, COPD, or signs of shock is 5 cmHâ‚‚O.

What is a contraindication for the use of PEEP in adults or children?

<p>Cardiac arrest is a contraindication for the use of PEEP in adults or children.</p> Signup and view all the answers

Describe how PEEP influences the functional residual capacity of the lungs.

<p>PEEP increases the functional residual capacity by allowing more air to remain in the lungs at the end of expiration.</p> Signup and view all the answers

In the case of cardiogenic pulmonary oedema, what PEEP setting should be applied?

<p>A PEEP setting of 10 cmHâ‚‚O should be applied for cardiogenic pulmonary oedema in adults.</p> Signup and view all the answers

What precautions should be taken when using PEEP in patients with an altered level of consciousness?

<p>PEEP should be used with caution in patients with an altered level of consciousness, vomiting, or signs of shock.</p> Signup and view all the answers

What is the PEEP setting for neonates including during cardiac arrest?

<p>The PEEP setting for neonates, including during cardiac arrest, is 5 cmHâ‚‚O.</p> Signup and view all the answers

What is the importance of obtaining informed consent before applying PEEP?

<p>Informed consent ensures that the patient understands the procedure, potential risks, and benefits, which is crucial for ethical and legal reasons.</p> Signup and view all the answers

How can a tight seal with the mask maximize the effects of PEEP?

<p>A tight seal prevents air leakage, enhancing the effectiveness of positive end-expiratory pressure during ventilation.</p> Signup and view all the answers

What risk does PEEP pose for patients with traumatic brain injury (TBI)?

<p>PEEP can increase intracranial pressure by reducing venous return from the brain, which can be detrimental to patients with TBI.</p> Signup and view all the answers

Why is PEEP not applied during CPR for adults and children?

<p>PEEP is contraindicated during CPR because it increases intrathoracic pressure, which can reduce blood flow achieved during resuscitation.</p> Signup and view all the answers

What is a critical consideration for personnel when transporting patients on PEEP?

<p>Personnel must decide whether the risks of being unrestrained during transport are outweighed by the benefits of continuing PEEP for the patient.</p> Signup and view all the answers

How does 0.9% sodium chloride IV relate to the application of PEEP?

<p>Administering 0.9% sodium chloride IV can help expand intravascular volume, which may benefit patients with compromised right ventricular filling when PEEP is applied.</p> Signup and view all the answers

What should be done if a patient shows signs of shock while receiving PEEP via a manual bag?

<p>Caution should be exercised, and if the patient shows signs of shock, the application of PEEP must be reevaluated and possibly stopped.</p> Signup and view all the answers

What is a key step in preparing PEEP for application?

<p>A key step is attaching the PEEP valve to the manual ventilation bag properly and ensuring the correct settings are applied for the patient.</p> Signup and view all the answers

What are the indications for using PEEP during ventilation?

<p>PEEP is indicated when a manual ventilation bag is used and for patients with cardiogenic pulmonary edema when CPAP is unavailable.</p> Signup and view all the answers

Why might PEEP be uncomfortable for conscious patients?

<p>PEEP can increase pressure in the airways and lungs, which may cause anxiety and discomfort for patients who are awake and aware.</p> Signup and view all the answers

Flashcards

Positive End Expiratory Pressure (PEEP)

A technique where positive pressure is maintained in the lungs during exhalation, improving oxygenation, ventilation, and reducing breathing effort.

PEEP's effect on lung collapse

PEEP helps prevent small and medium-sized airways from collapsing during exhalation.

PEEP and heart preload

PEEP reduces venous return to the heart, lessening the filling (preload) of the right ventricle.

PEEP and right ventricle afterload

PEEP increases the afterload (resistance to blood flow out) of the right ventricle, reducing blood flow through lung vessels.

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PEEP and functional residual capacity

PEEP increases the amount of air remaining in the lungs at the end of exhalation, leading to more lung expansion.

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PEEP and breathing work

More lung expansion from PEEP reduces the work required to breathe because of the lungs' non-linear compliance.

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PEEP application in cardiac arrest (adult)

Do not apply PEEP during adult cardiac arrest.

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PEEP setting for cardiogenic pulmonary oedema (adult)

Apply PEEP (10-15 cmH2O) in cardiogenic pulmonary oedema with caution and increase up to 15 if not improving.

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Indications for PEEP

PEEP is used when a manual ventilation bag is used and in cases of cardiogenic pulmonary edema (when CPAP isn't available).

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PEEP Contraindications (adults/children)

PEEP is not used during CPR for adults or children.

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PEEP Contraindications - Caution (neonates)

For neonates, PEEP is used during CPR because the cause often is respiratory failure, whereas adults have different reasons for their cardiac arrests.

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PEEP and TBI

PEEP increases intracranial pressure in patients with traumatic brain injury (TBI) by reducing venous return from the brain.

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PEEP setting for TBI

For patients with TBI, set PEEP to 5 cm Hâ‚‚O to balance oxygenation with intracranial pressure.

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PEEP mask seal

A tight seal with the mask is crucial to maximize its effects.

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PEEP during transport

Balancing the risk of personnel injury against the need for PEEP during transport is crucial, particularly with unrestrained personnel.

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IV fluids with PEEP

Patients with right-ventricular issues may benefit from IV fluids (0.9% saline) concurrently with PEEP.

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PEEP during CPR (general)

In general, PEEP is not used with adults or children undergoing CPR. It's inappropriate.

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Applying PEEP - assessment expectations

When demonstrating PEEP application during assessment, the assessor checks your skill in attaching the valve to a manual bag, setting the appropriate value, and ensuring a correct mask seal; and ventilation as needed, all in accordance with patient age and/or weight.

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Study Notes

Positive End Expiratory Pressure (PEEP)

  • Mechanism of Action: PEEP improves oxygenation, ventilation, and reduces breathing effort by keeping airways open during exhalation, reducing right ventricle preload (filling) and afterload, and increasing functional residual capacity (FRC), promoting lung expansion.

  • Indications:

    • Manual ventilation using a bag.
    • Cardiogenic pulmonary edema if CPAP is unavailable.

  • Contraindications and Cautions:

    • Contraindications: Cardiac arrest in adults and children (neonates excluded).
    • Cautions:
      • Ventilation via ETT or LMA with shock.
      • Applying PEEP with a manual bag and mask to a patient with altered consciousness, vomiting, or shock.

PEEP Procedure

  • Setup: Attach PEEP valve to the ventilation bag, adjust the cap to the appropriate setting.
  • Informed Consent: Obtain informed consent (particularly for cardiogenic pulmonary edema patients).
  • Seal: Maintain a tight seal with the mask to maximize effects.

PEEP Settings

  • Adults (non-cardiac arrest):
    • TBI, COPD, asthma, or shock: 5 cmHâ‚‚O
    • Other conditions: 10 cmHâ‚‚O
    • Cardiogenic pulmonary oedema:
      • Initial setting: 10 cmHâ‚‚O
      • Increase to 15 cmHâ‚‚O if no improvement.
      • Do not assist breathing unless ineffective.
  • Children (non-cardiac arrest): 5 cmHâ‚‚O
  • Neonates: 5 cmHâ‚‚O (including during cardiac arrest).
  • Cardiac Arrest (adults/children): Do not use PEEP.

Potential Complications

  • Increased intracranial pressure (ICP): PEEP can elevate ICP in patients with traumatic brain injury (TBI). A lower setting (5 cmHâ‚‚O) is used in these cases. Prioritize oxygenation while balancing the risk of increased ICP.
  • Patient discomfort: PEEP can be anxiety-provoking and uncomfortable for conscious patients. Provide reassurance and support.

PEEP During Transport

  • Safety: Patient and personnel must be safely restrained during transport.
  • Balancing Risks: Weigh the risks to personnel (potential unrestrained transport) against the risk to the patient (not receiving PEEP).
  • Optimizing Circumstances: If patient is improving quickly, consider staying on scene.
  • Safe Transport Principles: Explicit decision regarding the balance of risk, maintaining normal road speed, modified driver behavior for safety.

Additional Information

  • Fluid management: Patients with reduced right ventricular filling or increased afterload may benefit from intravenous fluids (0.9% saline).
  • CPR and PEEP: Avoid PEEP during adult/child CPR (decreases blood flow). Apply PEEP if ROSC is achieved, but it's not an immediate priority.
  • Neonatal CPR and PEEP: Neonatal CPR often uses PEEP because the cause is frequently respiratory failure, prioritizing improved ventilation in balance to blood flow reductions.

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