Highest PEEP you've seen?

  1. 1 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?
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    Visit  poppy07 profile page

    About poppy07

    Joined Oct '07; Posts: 206; Likes: 37.

    23 Comments so far...

  4. Visit  Guinness02 profile page
    0
    25 is the highest that you will see for the most part. To need to be on 25 of PEEP the pts lungs are usually very non-compliant because of ARDS, and the risk for barotrauma is high with these patients.
    I have seen pneumothoracis associated with PEEP settings this high because there Plateau Pressures are usually elevated also. To minimize the risk pneumothorax the use of low tidal volume strategies should be employed.
  5. Visit  poppy07 profile page
    0
    this pt was finally stabilized on 25 peep, cmv, tv 450, rate 35. can you tell me a little about the plateau pressures and the pneumothoracis? Also, at what point does resp. distress actually become defined as "ARDS"? Thanks!
  6. Visit  ukstudent profile page
    0
    I am going to recommend that you visit www.icufaqs.org, this web site will be able to answer a lot of your questions. Get a good ICU book, as nursing school books to not go into enough depth about respiratory and hemodynamics problems as you will need to know and understand to be an ICU nurse.
  7. Visit  Guinness02 profile page
    0
    Plateau pressures are obtained by doing an inspiratory hold on the ventilator. When you do this the ventilator gives you the peak alveolar pressure. Ideally this number should be < 30. Numbers greater then 30 are associated with higher rates of barotrauma (pneumothorax), and volutrauma (lung parenchymal injury). Essentially the pressure in the alveoli becomes to great in relationship with the poor compliance of the lungs so they are at risk to "pop"(pneumo).
    Respiratory distress becomes defined as ARDS when you have bilateral infiltrates on CXR, with a PaO2 to FiO2 ratio of < 200 (PaO2 of 50 with a FiO2 of 1.0 = a PaO2/FiO2 ratio of 50). This needs to be in the presence of a PAOP of less then or equal to 18 so that it is not related to cardiac dysfunction.

    Hope this helps.
  8. Visit  poppy07 profile page
    0
    Paop?
  9. Visit  Guinness02 profile page
    0
    Pulmonary Artery Occlusion Pressure, sorry.
  10. Visit  poppy07 profile page
    0
    Unless you're used to having swans, I'm not sure how you'd even be obtaining this....
  11. Visit  AliRae profile page
    0
    25?! holy cow ... once we're up to 10 we consider the oscillator!

    I picked up a kid recently who was on a PEEP of 16, but we weaned him pretty darn quick because no one felt like putting in chest tubes in the back of the rig.
  12. Visit  GrnHonu99 profile page
    0
    here in neuro land we generally dont go over PEEP of 5.
  13. Visit  gwenith profile page
    0
    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.
  14. Visit  bluesky profile page
    0
    We usually go to APRV in true ARDS. Haven't seen much above 15 of PEEP in CMV where I've practiced.
  15. Visit  bluesky profile page
    0
    We usually go to APRV in true ARDS. Haven't seen much above 15 of PEEP in CMV where I've practiced.


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