Positive End-exspiratory Pressure during Mechanical Ventilation – State-of-the-art

Overview

Application of positive end-exspiratory pressure (PEEP) represents an integral part of ventilatory strategy. Application of PEEP addresses severalpathophysiologic targets: functional residual capacity, ventilation/perfusion distribution, decrease of intrinsic PEEP in patients with limited respiratorytract flow. Clinical aspects of PEEP application are evident in improvement of oxygenation, improvement of patient/ventilator synchrony, decrease ofwork of breathing, limiting of ventilator-induced lung injury. PEEP increases end-exspiratory lung volume (EELV) and also influences distribution ofventilation and perfusion, pulmonary shunt and alveolar ventilation. For optimal PEEP setting, there are used methods based on monitoring mechanicalcharacteristics of respiratory system, methods derived from monitoring changes in PaO2 as derived value for EELV, and their combination.

Key words:
mechanical ventilation – positive end-exspiratory pressure – VILI – compliance – oxygenation