4 uses of PEEP in an ICU

What is PEEP? Positive End Expiratory Pressure is a setting on the ventilator or NIV that is used to ensure there is a remaining amount of pressure at the end of exhalation.

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4 Uses:

- Increases in PEEP are used to increase oxygenation by recruiting alveoli. The more alveoli you pop open and recruit means there will be more alveoli participating in gas exchange. - Increases in PEEP can be used to treat a CHF Exacerbation causing Pulmonary Edema. This can be achieved noninvasively with CPAP or BiPAP. By increasing the PEEP you are able to push the excess fluid in the lungs back out into the interstitial spaces and out of the alveoli. Giving Lasix or some kind of diuretic also helps the patient get the extra fluid off. - Increases in PEEP can also help support the right heart during right heart failure.  Increases in PEEP causes decreased central venous return from the inferior and superior vena cava and gives the right heart receiving the blood a chance to catch up while pumping without being flooded with more blood than it can handle. - Increases in PEEP can help a patient with Pulmonary Hemmohorage.  If a patient is bleeding from their lungs, increasing peep can help squeeze and put pressure on the bleeding site. Imagine you accidentally slice your hand with a knife, the first thing you do is put pressure to stop the bleeding. It's the same concept here. Increase the pressure to decrease the bleeding. HAZARDS - Increasing PEEP too much can lead to hemodynamic instability by decreasing blood flow going to the right heart. Watch your CVP, blood pressure, and heart rate. Even though increasing PEEP can help support the right heart, too much of it can lead to hemodynamic instability.