Highest PEEP you've seen?

There has been a distinct trend over the last few years to keep PEEP below 10 whenever possible - Once you get over 15 alternate ventilation strategies start being employed.

We usually go to APRV in true ARDS. Haven't seen much above 15 of PEEP in CMV where I've practiced.

We usually go to APRV in true ARDS. Haven't seen much above 15 of PEEP in CMV where I've practiced.

I've seen 25cm PEEP, but it's pretty scary. The patient was a 23 yr old postpartum amniotic fluid embolus ARDS patient. Multiple chest tubes for pneumothoraces. Could not tolerate suctioning back in the day before closed suction systems. She survived and we were quite pleased. She still sees the doc that managed her ventilator! That was at least 28 years ago! This is how she looked some days:

I'm with Gwenith on this one.....

On neuro patients, we rarely ever go above 5, but have seen as high as 10...then other vent. methods start being used....i.e. pressure control ventilation or whatever is appropriate. Now with these patients, our intensivists handle their vents, etc.

On trauma patients, I've seen as high as 15, but that's about it. With those, the trauma service tends to handle all their own stuff.....medical management, etc....but I do see a little change coming with that. They've been using the intensivists more now too.

Our intensivists are also pulmonologists (dual specialties), so our vent management is some of the best you'll ever see....those guys are AMAZING!!! IMHO, we have some of the BEST critical care medical management you'll ever see!!

37.5

Which was as high as the vent would go.

Yes, she blew out her lung (or......we blew out her lung)..... and was asystole pretty quickly afterwards.

She was young and otherwise healthy, in an MVA.

She had been in the hospital <16 hrs.

We all knew she wasn't going to live, but she was only 19 so we were doing whatever we could. My shift was almost over and I had decided that I was going to have to do the admission paperwork since it looked like she was going to live through my shift. I had just sat down with her mom to get her nursing history done -- and the vent started alarming. She was asystole before I could get up and walk the five steps into the room.

37.5?

Wow. I think [i]MY[i] lung just popped!

My question would be....what the heck was this pt's ICP????? With a peep of 25 (great for ARDS...BAD for brain) I would expect the ICP to be, oh say, 50! I mean think about the pathophys of this...peep increases intrathoracic pressure which impends venous flow from the jugulars & therefore creating increased ICP, right? At a peep of 25 I have to wonder why the neurosurgeon wasn't having a coronary over this! (assuming the pt had a head injury) In our unit we often have high peeps when it's last ditch effort to overcome ARDS but very rarely because of the ICP issue.

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I can't imagine a possible scenario that a level of PEEP that high would help. What are the units of measure?

28, last ditch effort, pt died anyway