To PEEP or not to PEEP?

Abstract

It is well recognised that reducing positive end expiratory pressure (PEEP) leads to an increase in the tidal volume and minute volume in ventilated neonates.

Appropriate positive end expiratory pressure level in surfactant-treated preterm infants

“…One explanation for the CO 2 retention is that increasing PEEP while maintaining the peak inspiratory pressure reduces the``pressure drop'' and hence the delivered and minute volume. Even small changes in PEEP aect delivered volume [1]. Increasing PEEP by 1 cmH 2 O is twice as eective as a 2 cmH 2 O decrease in the PIP in reducing tidal volume [1].…”

“…Even small changes in PEEP aect delivered volume [1]. Increasing PEEP by 1 cmH 2 O is twice as eective as a 2 cmH 2 O decrease in the PIP in reducing tidal volume [1]. An alternate explanation for the CO 2 retention is that the elevation of PEEP resulted in alveolar overdistension.…”

The effect of positive endexpiratory pressure, peak inspiratory pressure, and inspiratory time on functional residual capacity in mechanically ventilated preterm infants

“…Higher PEEP levels appear to reduce lung damage in a rabbit model of neonatal respiratory distress syndrome [23]. Inappropriately high PEEP, however, may impair expiration, decrease tidal volume, minute ventilation [1] and cardiac output [20] and may lead to over-distension of the lung, interstitial emphysema, pneumothorax and pneumopericardium [8]. The best pulmonary compliance is achieved with a PEEP that normalizes FRC [28].…”

High frequency oscillatory ventilation in infants with increased intra-abdominal pressure

“…Hypercapnia ensues when abdominal distension becomes severe enough to impair alveolar expansion during inspiration, resulting in alveolar hypoventilation. The use of a high positive end-expiratory pressure may reduce alveolar collapse during expiration, but may cause further reduction in tidal volume with an increase in PaCO 2 1. A positive end-expiratory pressure of 7 cm H 2 O had been tried in four of the infants but had resulted in further deterioration of hypercapnia without improvement in oxygenation.…”