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?
Guinness02 5 Posts Nov 2, 2007 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.
poppy07 208 Posts Nov 2, 2007 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!
ukstudent 805 Posts Specializes in SICU. Nov 2, 2007 I am going to recommend that you visit http://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.
Guinness02 5 Posts Nov 2, 2007 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 Respiratory distress becomes defined as ARDS when you have bilateral infiltrates on CXR, with a PaO2 to FiO2 ratio of Hope this helps.
poppy07 208 Posts Nov 2, 2007 Unless you're used to having swans, I'm not sure how you'd even be obtaining this....
AliRae 1 Article; 421 Posts Specializes in PICU, surgical post-op. Has 4 years experience. Nov 5, 2007 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.
GrnHonu99, RN 1,459 Posts Specializes in Neuro, Critical Care. Nov 18, 2007 here in neuro land we generally dont go over PEEP of 5.
gwenith, BSN, RN 3,755 Posts Specializes in ICU. Nov 24, 2007 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.
bluesky, BSN, RN 864 Posts Specializes in Critical Care, ER. Has 4 years experience. Nov 27, 2007 We usually go to APRV in true ARDS. Haven't seen much above 15 of PEEP in CMV where I've practiced.
