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Auto-PEEP in respiratory failure Journal Article
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| Authors: | Laghi, F.; Goyal, A |
| Article Title: | Auto-PEEP in respiratory failure |
| Abstract: | Intrinsic positive end-expiratory pressure (auto-PEEP) is a common occurrence in patients with acute respiratory failure requiring mechanical ventilation. Auto-PEEP can cause severe respiratory and hemodynamic compromise. The presence of auto-PEEP should be suspected when airflow at end-exhalation is not zero. In patients receiving controlled mechanical ventilation, auto-PEEP can be estimated measuring the rise in airway pressure during an end-expiratory occlusion maneuver. In patients who trigger the ventilator or who are not connected to a ventilator, auto-PEEP can be estimated by simultaneous recordings of airflow and airway and esophageal pressure, respectively. The best technique to accurately measure auto-PEEP in patients who actively recruit their expiratory muscle remains controversial. Strategies that may reduce auto-PEEP include reduction of minute ventilation, use of small tidal volumes and prolongation of the time available for exhalation. In patients in whom auto-PEEP is caused by expiratory flow limitation, the application of low-levels of external PEEP can reduce dyspnea, reduce work of breathing, improve patient-ventilator interaction and cardiac function, all without worsening hyperinflation. Neurally adjusted ventilatory assist, a novel strategy of ventilatory assist, may improve patient-ventilator interaction in patients with auto-PEEP. |
| Journal Title: | Minerva anestesiologica |
| Volume: | 78 |
| Issue: | 2 |
| ISSN: | 1827-1596; 0375-9393 |
| Publisher: | Unknown |
| Journal Place: | Italy |
| Date Published: | 2012 |
| Start Page: | 201 |
| End Page: | 221 |
| Language: | English |
| DOI/URL: | |
| Notes: | ID: 12478; Record Owner: From MEDLINE, a database of the U.S. National Library of Medicine.; Status: MEDLINE; [Review]; Publishing Model: Journal available in: Print-Electronic Citation processed from: Internet; NLM Journal Code: n26, 0375272; Electronic Date of Publication: 20111118; Entry Date: 20120806 |
