Pulmonology Book

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Positive End-Expiratory Pressure

Aka: Positive End-Expiratory Pressure, PEEP
  1. Indications
    1. Pulmonary condition with widespread alveolar collapse
    2. Adult Respiratory Distress Syndrome (ARDS)
      1. PEEP increases lung compliance
      2. PEEP decreases intrapulmonary shunting
      3. Increases PO2 and allows lower FIO2 below 60%
      4. May increase dead space ventilation
        1. Overdistends normal lung
    3. Pulmonary Edema
      1. PEEP allows decrease in FIO2 below 60%
      2. PEEP may increase extravascular lung water
  2. Disproved uses of PEEP
    1. Localized Lung Disease (e.g. lobar Pneumonia)
      1. PEEP may worsen Hypoxemia
        1. Overdistends normal lung
        2. Directs blood flow to diseased lung
      2. PEEP not recommended
        1. Unless selectively applied to diseased lung
    2. Prophylactic PEEP
      1. PEEP does not reduce ARDSIncidence
    3. Routine PEEP
      1. PEEP does not appear indiscriminately beneficial
    4. Mediastinal Bleeding
      1. PEEP does not protect against mediastinal bleeding
  3. Physiology
    1. PEEP maintains small end-expiratory pressure
      1. Helps to prevent alveolar collapse
      2. Promotes alveolar-capillary gas exchange
    2. Increases lung function parameters
      1. Increases Functional Residual Capacity (FRC)
    3. Increases cardiac output with low airway pressures
      1. May result in increased Oxygen Delivery
  4. Dosing
    1. Usual PEEP setting: 5 to 10 cm H2O
  5. Complications
    1. Decreased cardiac output
      1. Associated with higher airway pressures
      2. Associated with decreased ventricular filling
    2. Barotrauma
    3. Fluid Retention
    4. Intracranial Hypertension
  6. References
    1. Marino (1991) ICU Book, Lea & Febiger, p. 375-9

Positive End-Expiratory Pressure (C0032740)

Definition (MSH) A method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange.
Definition (CSP) method of mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration, thus reducing the shunting of blood through the lungs and improving gas exchange.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D011175
SnomedCT 250854009
English End-Expiratory Pressure, Positive, End-Expiratory Pressures, Positive, PEEP, Positive End Expiratory Pressure, Positive End-Expiratory Pressures, Positive Pressure Respiration, Positive-Pressure Respiration, Positive-Pressure Respirations, Pressure, Positive End-Expiratory, Pressures, Positive End-Expiratory, Respiration, Positive-Pressure, Respirations, Positive-Pressure, positive pressure breathing, PEEP-Positive end expirat pres, Positiv end expiratory pressur, Positive-Pressure Ventilation, Positive Pressure Ventilation, Ventilations, Positive-Pressure, Ventilation, Positive-Pressure, Positive-Pressure Ventilations, Positive End-Expiratory Pressure, positive pressure respiration, Pressure.positive end expiratory, positive end expiratory pressure (PEEP), positive end-expiratory pressure, positive end expiratory pressure, peeps, peep, Positive end-expiratory pressure, PEEP - Positive end expiratory pressure, Positive end expiratory pressure, Positive end expiratory pressure (observable entity)
Italian Pressione positiva al termine dell'espirazione, Pressione positiva tele-espiratoria, Ventilazione a pressione positiva, Pressione positiva di fine espirazione, PEEP, Respirazione a pressione positiva
French PEP (pression expiratoire positive), Pression expiratoire positive, PEEP (Positive End Expiratory Pressure), VPP (Ventilation en Pression Positive), Ventilation en pression positive, PEP (Pression Expiratoire Positive), Pression de fin d'expiration positive
Spanish PTEP, PEEP, presión positiva al final de la espiración (entidad observable), presión positiva al final de la espiración, Presión tele-espiratoria positiva, PEFP, Presion Positiva Expiratoria Final, Respiracion con Presion Positiva, Respiracion por Presion Positiva Continua, Presión Positiva Expiratoria Final, Respiración por Presión Positiva Continua, Respiración con Presión Positiva
Japanese ＰＥＥＰ, ｼｭｳﾏﾂｺｷﾖｳｱﾂ, PEEP, 陽圧換気, 陽圧人工換気, 陽圧呼吸法, 終末呼気陽圧, 陽圧呼吸, 呼吸-陽圧
Swedish Övertrycksventilation
Czech ventilace umělá s výdechovým přetlakem, kontinuální přetlak v dýchacích cestách, PEEP, Pozitivní tlak na konci expiria
Finnish Ylipainehengitys
Russian DYKHANIE ISKUSSTVENNOE POD POLOZHITEL'NYM DAVLENIEM, ДЫХАНИЕ ИСКУССТВЕННОЕ ПОД ПОЛОЖИТЕЛЬНЫМ ДАВЛЕНИЕМ
Croatian POZITIVNI TLAK NA KRAJU IZDISAJA
Polish Wentylacja ciśnieniami dodatnimi, Dodatnie ciśnienie końcowo-wydechowe
Hungarian PEEP, Pozitív kilégzésvégi nyomás
Portuguese Pressão expiratória final positiva, PEEP, Pressão Expiratória Final Positiva, Respiração com Pressão Positiva, Respiração por Pressão Positiva Contínua
Dutch positive end-expiratory pressure, Druk, Eindexpiratoire positieve, Overdrukbeademing, PEEP, Positieve-drukbeademing, Positieve-drukventilatie, Ventilatie, positieve-druk-
German positiver endexpiratorischer Druck, PEEP, Positiver endexspiratorischer Druck, Überdruckbeatmung
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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