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How to choose your optimal PEEP?
Have a seat, bring your coffee and let’s move on.
N.B: this is not a reference, it is just flashes to what you need to know
#MedTwitter #CriticalCare #ventilators #ICU #COVID19 #respiratory_therapy
Have a seat, bring your coffee and let’s move on.
N.B: this is not a reference, it is just flashes to what you need to know
#MedTwitter #CriticalCare #ventilators #ICU #COVID19 #respiratory_therapy
Optimal PEEP is the one gives you:
- Best Saturation
- Minimal End expiratory atelectasis
- Minimal End inspiratory overdistension
Please, never put a high PEEP and leave, check the Pplatue (avoid barotrauma) and double check the hemodynamic (significant preload reduction)
- Best Saturation
- Minimal End expiratory atelectasis
- Minimal End inspiratory overdistension
Please, never put a high PEEP and leave, check the Pplatue (avoid barotrauma) and double check the hemodynamic (significant preload reduction)
The idea of higher Vs lower PEEP is discussed in ALVEOLI, LOVS, and EXPRESS trials. A nice meta-analysis is there summing their result. Published in JAMA network. https://jamanetwork.com/journals/jama/fullarticle/185447
PEEP/ FiO2
This one can be fiund in http://ARDS.net table which has been suggested by ARMA trial
2 tables are available, lower PEEP and higher PEEP
This one can be fiund in http://ARDS.net table which has been suggested by ARMA trial
2 tables are available, lower PEEP and higher PEEP
PEEP to best driving pressure.
Adjust the PEEP and calculate the driving pressure (Pplatue – PEEP). The lower driving pressure the better the PEEP.
Driving pressure concept is discussed in more than one trial
One of them https://www.nejm.org/doi/full/10.1056/nejmsa1410639
Adjust the PEEP and calculate the driving pressure (Pplatue – PEEP). The lower driving pressure the better the PEEP.
Driving pressure concept is discussed in more than one trial
One of them https://www.nejm.org/doi/full/10.1056/nejmsa1410639
PEEP to best compliance.
Adjust the PEEP and calculate the static lung compliance. The better the compliance the better the PEEP
Compliance is calculated by dividing tidal volume/ driving pressure
Adjust the PEEP and calculate the static lung compliance. The better the compliance the better the PEEP
Compliance is calculated by dividing tidal volume/ driving pressure
PEEP slightly above the lower inflection point
The lower inflection point is where the alveoli start to open (theoretically keeping PEEP above will prevent atelectasis)
It can be determined (which is not an easy task) by Volume to pressure curve
The lower inflection point is where the alveoli start to open (theoretically keeping PEEP above will prevent atelectasis)
It can be determined (which is not an easy task) by Volume to pressure curve
PEEP to stress index =1
The same concept of inflection point where you ventilate the patient in the area with best recruitment and best compliance.
Here you determine it by pressure to time wave form in volume control mood.
Adjust the PEEP to get the strait pressure line.
The same concept of inflection point where you ventilate the patient in the area with best recruitment and best compliance.
Here you determine it by pressure to time wave form in volume control mood.
Adjust the PEEP to get the strait pressure line.
Dr. Mazen in his fantastic channel talked about it
PEEP to minimal dead space.
This achieved by adjusting the PEEP to level which gives you the minimal PaCO2-EtCO2 (end tidal CO2)
This achieved by adjusting the PEEP to level which gives you the minimal PaCO2-EtCO2 (end tidal CO2)
PEEP to minimal shunting
This required a pulmonary artery catheter so probably you will not see it.
شفت واحد بس وكان مركب في غرفة العمليات، من جانا المريض قالي الاستشاري اسحبه بنستخدمه
as central line
كان ودي آخذ وياه سلفي
This required a pulmonary artery catheter so probably you will not see it.
شفت واحد بس وكان مركب في غرفة العمليات، من جانا المريض قالي الاستشاري اسحبه بنستخدمه
as central line
كان ودي آخذ وياه سلفي
PEEP post recruitment.
After doing a recruitment maneuver, gradually decrease your PEEP till SpO2% drop by more than 2%. Go back, this is your desired PEEP
PHARLAP trial is good to be mentioned here.
After doing a recruitment maneuver, gradually decrease your PEEP till SpO2% drop by more than 2%. Go back, this is your desired PEEP
PHARLAP trial is good to be mentioned here.
PEEP to target transpulmonary pressure.
This need and esophageal probe.
Target transpulmonary pressure 0-10
TPP= Pplatue- Peso
This need and esophageal probe.
Target transpulmonary pressure 0-10
TPP= Pplatue- Peso
PEEP to best aerated lung
This need a multiple CT which I do not think anybody will fever (transporting unstable patient, radiation exposure)
The idea is the best PEEP is the one will give you more aerated lung in CT
This need a multiple CT which I do not think anybody will fever (transporting unstable patient, radiation exposure)
The idea is the best PEEP is the one will give you more aerated lung in CT
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