2. ؟What is The best PEEP
-No optimal way to assess "best PEEP“
- PEEP is added in increments of 2-3 cm until the
"best/optimal PEEP" is obtained, choose the level which
provides the highest static compliance and the lowest
airway plateau pressure
- PEEP above lower inflection point on static P-V curve
- PEEP at or over 12cm is rarely beneficial and usually
results in additional pressure-induced lung injury
3.
4. The best PEEP
Above the critical closing pressure
Effective PEEP should be set at 2-3 cm H2O
above the indicated collapse pressure as a
safety margin after a preceding recruitment
maneuver
Rogers textbook of pediatric intensive care
NO UNIVERSAL DEFINATION
5.
6.
7. 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.
13. Pulmonary heamorrhage
- Blood culture and consider full septic screen
-Cranial Ultrasound
- Echocardiogram is helpful is
assessing left ventricular function,
contractility and confirming the
presence of PDA if it is suspected
16. What is the normal range for Peep?
Most patients are started on 5 cm H2O of PEEP.
Some patients, such as those with ( RDS , ARDS)
or other conditions that make lungs stiff,
require higher levels of PEEP to keep alveoli
from collapsing and to decrease
intrapulmonary shunting.
It's not unusual to use 8 - 12 cm HO in these
patients
18. PEEP EFFECT
PEEP increases alveolar pressure and alveolar
volume.
The increased lung volume increases the surface
area by reopening and stabilizing collapsed or
unstable alveoli
TV. Important to avoid over-distension of alveoli
in the relatively normal parts of lung (Plateau
(pressure less 30 cmH2o
19. Positive end-expiratory pressure (PEEP)
Optimal PEEP
- improves gas exchange by maintaining alveolar patency
(open lung approach)
- Reduces the FiO2 required (high oxygen are toxic to the lung)
Too high PEEP will cause lung injury and impairs cardiac
high Paco2output
20.
21. KEY POINTS
-The best PEEP (No universal definition or PEEP )
- Ventilation protective strategy
- Disease specific ventilation strategy
Diseases required high PEEP ))
Editor's Notes
خير الامور الوسط
WITH PPN OR WITHOUT PPHN
Decrease left to right shunt, increase alveolar pressure prevent collapse ,
WE NEED TO OPEN THE LUNG AND ICREASE TV but not to over distension the lung
