[poppy07]

I had a patient the last 2 days on 25 of PEEP. The docs were concerned about her lungs
"popping," so for a while- we didn't move her. Finally, got it down to 15. What's the highest PEEP you've seen, and have you ever had a patient's lungs pop?

[Artemis2]

In the old days (25 years ago) we only had IMV ventilation with PEEP. There was no pressure support, SIMV or any of the other modern vent settings. There was very little we could change on a vent when a person was not doing well. After you had maxed out TV, FiO2 & rate all you could do was go up on the PEEP. 25 is about the highest I have seen but in those days it was much more common and yes, we caused quite a few pneumos.

Ventilators are so much more sophisticated these days that rarely do you have to go that high but every once in a while....

[elizabells]

Six. But that's babies. Our standard is five, and yes, we do get the occasional pneumo, but again, babies. Most of our iatrogenic pneumos occur during the intubation process.

[cardiacRN2006]

We just had one with 22. He has ARDS.

[TheNuttyNurse]

28 of PEEP is my highest. We usually try and switch those folks over to pressure control ventilation instead of volume control. Have seen a few pneumos...not too many.

[PageRespiratory!]

Originally Posted by poppy07

The docs were concerned about her lungs
"popping," ...............have you ever had a patient's lungs pop?

Ugh, almost as bad as calling it a "respirator"!

26cmH2O, on a 21 y/o with some wierd cardiomyopathy. Crazy pulmonary edema.

[ready4crna?]

25 here..

Worked with a surgeon once who would put in bilat. chest tubes at the 20cm PEEP mark "just in case"... I kid you not, prophylactic chest tubes.

[elizabells]

Originally Posted by ready4crna?

25 here..

Worked with a surgeon once who would put in bilat. chest tubes at the 20cm PEEP mark "just in case"... I kid you not, prophylactic chest tubes.

Okay, it may be because I just finished a horrific shift and I'm too tired to be tactful, but... that's the dumbest d*** thing I've ever heard. What a silly surgeon. How would you know where you exactly wanted the chest tube if there wasn't a pneumo yet? Or do adults always blow in the same place?

[ready4crna?]

No tact necessary, I agree with you. As for the chest tube placement- the pleural space is always present, and when you punch a hole in the cavity (whether by stabbing, GSW, or surgically) air is let in and the space expands,lung deflates, instant pneumotx. Place CT,repeat.

[VandyNurse714]

Then how come you see patients with 2, 3, 4 chest tubes? What you (Ready4CRNA) said about the pleural space makes sense, of course...but now my brain's a-wandering...