![Selecting Optimal Positive End-Expiratory Pressure
- PEEP should be set in proportion to the current oxygen requirement
because hypoxemia is usually a reflection of ventilation–perfusion
mismatch due to atelectasis and low lung volume.
- Therefore, using a PEEP of 5 cm H2O for all infants with] (RDS) is not optimal
for oxygenation and lung recruitment.[1
- Using high PEEP may lead to lung hyperinflation, air leak, pneumothorax,
decrease cardiac venous return, as well as higher PaCO2 (as VT will be
lower)
- Using low PEEP may lead to lung hypo inflation, lung collapse, and increase
requirement for FiO2.
- We recommend starting with a PEEP of 5–6 cm H2O.
- PEEP should be increased gradually up to 8 cm H2O if the FiO2 is more than
0.30 and/or there is evidence of low lung volume on chest X-ray.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Part 6 diseases specific ventilation strategy
- 1. Diseases specific ventilation strategy pediatric and neonatal mechanical ventilation6 Tageldin Aly part 6
- 2. Selecting Optimal Positive End-Expiratory Pressure - PEEP should be set in proportion to the current oxygen requirement because hypoxemia is usually a reflection of ventilation–perfusion mismatch due to atelectasis and low lung volume. - Therefore, using a PEEP of 5 cm H2O for all infants with] (RDS) is not optimal for oxygenation and lung recruitment.[1 - Using high PEEP may lead to lung hyperinflation, air leak, pneumothorax, decrease cardiac venous return, as well as higher PaCO2 (as VT will be lower) - Using low PEEP may lead to lung hypo inflation, lung collapse, and increase requirement for FiO2. - We recommend starting with a PEEP of 5–6 cm H2O. - PEEP should be increased gradually up to 8 cm H2O if the FiO2 is more than 0.30 and/or there is evidence of low lung volume on chest X-ray.
- 4. Diseases require High PEEP RDS,PDA,VSD,P.HGE
- 5. Diseases require medium PEEP MAS,BPD , PIE, myotonia , post surgery,
- 6. Diseases require medium PEEP
- 7. why require medium PEEP ? Post surgery (thoracic ,abdominal ) Abd. distension –decrease lung expansion Pain – restrict chest wall expansion
- 8. Normal VS. diseased lung (MAS,CLD,PIE) Myotonic dystrophy –weak chest wall ( loss physiological PEEP ) Diseased lung -MAS ,BPD with or without PPHN Normal lung minimal change in pressure create huge change in volume
- 9. BPD,MAS
- 10. Three Methods for Best PEEP Determination PEEP by Best oxygenation PEEP by Best Compliance PEEP by Esophageal pressure
- 11. How is PEEP calculated on a ventilator? BY P-V curve ( slopping curve ) PEEP and lung protection
- 12. Methods for Best PEEP Determination
- 13. PEEP volume VS. FRC
- 14. Method for Best PEEP Determination
- 15. Pplat measurement in volume mode ventilator
- 16. How to Choice ideal /optimal PEEP?
- 17. Clinical application of PEEP PEEP target VS. Oxygenation A decrease of PaO2 when PEEP is increased must be carefully investigated
- 18. 8 Methods for Best PEEP Determination
- 19. Methods for Best PEEP Determination
- 20. PEEP by Esophageal pressure
- 21. CONCLUSIONS: Digital chest x-ray done at the bedside in acute lung injury/ARDS subjects was able to detect a reduction in density between PEEP 5 cm H2O and PEEP 15 cm H2O, which correlated with Vrec.
- 22. How to assess PEEP-induced alveolar recruitment? BY LUNG US
- 23. CT LUNG & Electric impedance tomography (EIT) (FRC, Alveolar recruitment )images
- 24. Key points Diseases required medium PEEP How to monitor or calculate the optimal PEEP ? Bedside Clinical application and protective PEEP
Editor's Notes
- قانون نيو تين كل فعل له رد فعل مساوي له في المقدار ومضاد له في الاتجاه والهواء دخل في نهاية الشهيق الضغط ده اللي جوه هو بلاتوه اللي عايز يقاس measurement maximum plateau pressure 30 cmh2o we need to improve c stat
- ضعه علي اعلي شئ وبعدين نزل لبيب لحد ما تعرف المناسب للمريض