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词条 Positive end-expiratory pressure
释义

  1. Intrinsic PEEP (auto)

  2. Extrinsic PEEP (applied)

      Complications and Effects  

  3. History

  4. See also

  5. References

{{Update|date=November 2014}}

Positive end-expiratory pressure (PEEP) is the pressure in the lungs (alveolar pressure) above atmospheric pressure (the pressure outside of the body) that exists at the end of expiration.[1] The two types of PEEP are extrinsic PEEP (PEEP applied by a ventilator) and intrinsic PEEP (PEEP caused by an incomplete exhalation). Pressure that is applied or increased during an inspiration is termed pressure support.

Intrinsic PEEP (auto)

Auto (intrinsic) PEEP — Incomplete expiration prior to the initiation of the next breath causes progressive air trapping (hyperinflation). This accumulation of air increases alveolar pressure at the end of expiration, which is referred to as auto-PEEP.

Auto-PEEP develops commonly in high minute ventilation (hyperventilation), expiratory flow limitation (obstructed airway) and expiratory resistance (narrow airway).

Once auto-PEEP is identified, steps should be taken to stop or reduce the pressure build-up.[2] When auto-PEEP persists despite management of its underlying cause, applied PEEP may be helpful if the patient has an expiratory flow limitation (obstruction).[3][4]

Extrinsic PEEP (applied)

Applied (extrinsic) PEEP — is usually one of the first ventilator settings chosen when mechanical ventilation is initiated. It is set directly on the ventilator.

A small amount of applied PEEP (4 to 5 cmH2O) is used in most mechanically ventilated patients to mitigate end-expiratory alveolar collapse. A higher level of applied PEEP (>5 cmH2O) is sometimes used to improve hypoxemia or reduce ventilator-associated lung injury in patients with acute lung injury, acute respiratory distress syndrome, or other types of hypoxemic respiratory failure.[2]

Complications and Effects

Positive end-expiratory pressure can contribute to:

  • Decrease in
    • systemic venous return, CO, CI
    • PCWP, preload, blood pressure
  • Increase in:
    • Intrathoracic pressure, RV afterload (CVP and PAP)
    • FRC
  • Pulmonary barotrauma can be caused. Pulmonary barotrauma is lung injury that results from the hyperinflation of alveoli past the rupture point.
  • The effects of PEEP on intracranial pressure (ICP) have been studied. Although PEEP is hypothesized to increase ICP due to impedance of cerebral blood flow, it has been shown that high PEEP does not increase ICP.[7][3]
  • Renal functions and electrolyte imbalances, due to decreased venous return metabolism of certain drugs are altered and acid-base balance is impeded.[4]

History

John Scott Inkster an English anaesthetist and physician is credited with discovering PEEP.[5]

When his discovery was published in the proceedings of the World Congress of Anaesthesia in 1968, Inkster called it Residual Positive Pressure.

See also

  • Positive pressure ventilation
  • Positive airway pressure

References

1. ^{{cite web |url= http://medical-dictionary.thefreedictionary.com/positive+end-expiratory+pressure+%28PEEP%29 |work= TheFreeDictionary.com |title= Positive end-expiratory pressure (PEEP)}} Citing: {{Cite book |title= Saunders Comprehensive Veterinary Dictionary |year= 2007}}
2. ^{{cite journal |last1= Smith |first1= RA |title= Physiologic PEEP |journal= Respir Care |year= 1988 |volume= 33 |page= 620}}
3. ^{{cite journal |last1= Caricato |first1= A |last2= Conti |first2= G |last3= Della Corte |first3= F |last4= Mancino |first4= A |last5= Santilli |first5= F |last6= Sandroni |first6= C |last7= Proietti |first7= R |last8= Antonelli |first8= M |displayauthors= 4 |title= Effects of PEEP on the intracranial system of patients with head injury and subarachnoid hemorrhage: The role of respiratory system compliance |journal= The Journal of Trauma and Acute Care Surgery |volume= 58 |issue= 3 |pages=571–6 |date= March 2005 |pmid=15761353 |doi= 10.1097/01.ta.0000152806.19198.db|citeseerx= 10.1.1.500.2886 }}
4. ^{{cite journal |last1= Oliven |first1= A |last2= Taitelman |first2= U |last3= Zveibil |first3= F |last4= Bursztein |first4= S |title= Effect of positive end-expiratory pressure on intrapulmonary shunt at different levels of fractional inspired oxygen |journal= Thorax |volume= 35 |issue= 3 |pages= 181–5 |date= March 1980 |pmid= 6770485 |pmc= 471250 |doi= 10.1136/thx.35.3.181|url= http://thorax.bmj.com/content/35/3/181.long}}
5. ^{{cite journal |last= Craft |first= Alan |title= John Scott Inkster |journal= BMJ |type= obituary |doi= 10.1136/bmj.d7517 |date= December 13, 2011 |volume= 343 |page= D7517}}
6. ^1 {{cite journal |last1= Caramez |first1= MP |title= Paradoxical responses to positive end-expiratory pressure in patients with airway obstruction during controlled ventilation |journal= Crit Care Med |year= 2005 |volume= 33 |issue= 7 |pages= 1519–28 |pmid= 16003057 |pmc= 2287196 |last2= Borges |first2= JB |last3= Tucci |first3= MR |last4= Okamoto |first4= VN |last5= Carvalho |first5= CR |last6= Kacmarek |first6= RM |doi= 10.1097/01.CCM.0000168044.98844.30 |last7= Malhotra |first7= A |last8= Velasco |first8= IT |last9= Amato |first9= MB |display-authors= 4}}
7. ^1 {{cite journal |last1= Smith |first1= TC |last2= Marini |first2= JJ |title= Impact of PEEP on lung mechanics and work of breathing in severe airflow obstruction |journal= J Appl Physiol |year= 1988 |volume= 65 |issue= 4 | pages= 1488–99 |pmid= 3053583|doi= 10.1152/jappl.1988.65.4.1488 }}
8. ^1 {{cite journal |last1= Kondili |first1= E |last2= Alexopoulou |first2= C |last3= Prinianakis |first3= G |last4= Xirouchaki |first4= N |last5= Georgopoulos |first5= D |displayauthors= 4 |title= Pattern of lung emptying and expiratory resistance in mechanically ventilated patients with chronic obstructive pulmonary disease |journal= Intensive Care Med |year= 2004 |volume= 30 |issue= 7 |pages= 1311–8 |pmid= 15054570 |doi= 10.1007/s00134-004-2255-z}}
9. ^1 {{cite journal |last1= Frost |first1= EA |title= Effects of positive end-expiratory pressure on intracranial pressure and compliance in brain-injured patients |journal= J Neurosurg |year= 1977 |volume= 47 |issue= 2 |pages= 195–200 |pmid= 327031 |doi= 10.3171/jns.1977.47.2.0195}}
10. ^{{cite journal|author1=Eremenko AA |author2=Borisov RIu |author3=Egorov VM |journal=Anesteziol Reanimatol | year= 2011 |pages= 43–7 | pmid=21851022| title=Evaluating the effectiveness of "open lung" maneuvre| issue=3 }}
11. ^{{cite journal|vauthors=Hillman NH, Nitsos I, Berry C, Jane Pillow J, Kallapur SG, Jobe AH | title=Positive end-expiratory pressure and surfactant decrease lung injury during initiation of ventilation in fetal sheep| journal=Am J Physiol Lung Cell Mol Physiol | year= 2011 | volume= 301 | issue= 5 | pages= L712–20 | pmid=21856815 | doi=10.1152/ajplung.00157.2011| pmc=3290453}}
12. ^{{cite journal| author=Kaczmarczyk G| title=Pulmonary-renal axis during positive-pressure ventilation| journal=New Horiz | year= 1994 | volume= 2 | issue= 4 | pages= 512–7 | pmid=7804800 }}
13. ^{{cite journal|vauthors=Dehne MG, Meister M, Röhrig R, Katzer C, Mann V | title=Effects of inverse ratio ventilation with PEEP on kidney function| journal=Renal Failure | year= 2010 | volume= 32 | issue= 4 | pages= 411–6 | pmid=20446776 | doi=10.3109/08860221003672176 }}
14. ^{{cite journal|vauthors=Huynh T, Messer M, Sing RF, Miles W, Jacobs DG, Thomason MH | title=Positive end-expiratory pressure alters intracranial and cerebral perfusion pressure in severe traumatic brain injury| journal=J Trauma | year= 2002 | volume= 53 | issue= 3 | pages= 488–93 | pmid=12352486 | doi=10.1097/01.TA.0000025657.37314.2F }}
15. ^{{cite journal|vauthors=Hasan FM, Beller TA, Sobonya RE, Heller N, Brown GW | title=Effect of positive end-expiratory pressure and body position in unilateral lung injury | journal=J Appl Physiol | year= 1982 | volume= 52 | issue= 1 | pages= 147–54 | pmid=7037709 }}
[6][7][8][9]
}}

4 : Respiratory system procedures|Intensive care medicine|Mechanical ventilation|Respiratory therapy
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