Critical Care Scenarios TIRBO #28: How I set PEEP
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Feb 8, 2023 Dive into the nuances of setting PEEP in critical care! Explore the ideal balance between alveolar recruitment and over-distension. Discover the limitations of PEEP-FiO2 tables and how the stress index reveals vital ventilation insights. Learn to use pressure-volume loops to pinpoint optimal settings and the role of esophageal manometry in refining decisions. Gain practical tips for conducting driving-pressure trials to find the best PEEP, and understand the importance of frequent reassessment. It's a must-listen for those in critical care!
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There Is A Patient-Specific Ideal PEEP
- There is an ideal PEEP for each patient that balances alveolar recruitment and over-distention.
- That ideal PEEP changes with time and disease dynamics, so it is not fixed.
Use PEEP Tables As A Starting Point
- Use a PEEP-FiO2 table as a simple starting point, especially for protocols or non-experts.
- Treat it as a blunt tool and move to physiologic methods when possible.
Stress Index Reveals Intra-Breath Compliance
- The stress index inspects inspiratory pressure waveform shape to infer intra-breath compliance changes.
- Convex shapes suggest recruitment; concave shapes suggest over-distention toward end-inspiration.