Highest PEEP you've seen?

cm H2O? Isn't that what PEEP is usually measured in?

I never said it was helpful ... in fact, I think it directly contributed to her (immediate) death. She would have died anyway, though.

But, she was young and healthy pre-mva, and they were trying everything/anything they could.

It didn't help that they didn't really know what her injuries were.

It was a long time ago (>5years), so I may be forgetting some details, but she went straight to the OR from the ER. Her Xlap was negative. I don't think she ever made it to CT (too unstable).

She did have a bolt in place, but I remember it not working well. I remember talking with neurosurgery on call that night, and they pretty much told me she wasn't going to live.

She had a PA catheter, and the SVO2 wouldn't measure (too low to measure), hence the increase in the PEEP. I don't remember what the pO2 on the ABGs were, but I do remember that they were low enough to validate the SVO2 being too low to measure. Her FiO2 was already 1.00, so increasing PEEP was the only thing they could do. The vent wouldn't go any higher than 37.5.

But, the question was "highest PEEP you've seen," not "highest PEEP you've seen that has been beneficial."

I've nurse patients with PEEP of 20 (this was a long time ago mind) but not neuro patients we try to keep those to below 5 if possible. If higher PEEP is needed we tend to Oscilate our patients

Usually at levels of 15 cmH20 significant hypotension occurs. APRV is a great alternative mode however you need very skilled practitioners to use it (Properly) and to understand and Identify the changes that are need and occur. As someone else mentioned, usually when a patient requires more than 15 cmH20 of PEEP, alternative ventilation strategies are employed such as prone ventilation and/or permissive hypercapnia with ARDS settings (high RR with Low Vt) or pressure control. ARDS and someone requiring a PEEP of greater than 15 is going to have a significant mortality rate.

I was an ICU nurse a bazillion years ago so I know things have changed, but I routinely saw PEEPs of 40-50 even 60. Of course these people had full blown ARDS, most did not get pneumos, and I even saw a few recover!