PIP ventilator settings

Peak Respiratory Pressure: Pressure (resistance) at the end of expiration. Just when initiating the inspiration. Normal (20 cm H2O)= 14.71 mmHg.

• Reasons for increasing: blockage of airways by sputum/barotrauma
  
• stiffer lung (non-compliant)= higher PAP
  

High airway pressure- in addition to providing alarm breath should be pressure limited and thus patient will only receive part of the preset tidal volume

- if pressure limit is repeatedly exceeded patient should be disconnected and manually ventilated while problem diagnosed. Initial steps are to check for ETT blockage and ventilator malfunction. Other factors to consider are airway resistance, pneumothorax, endobronchial intubation

- causes of high airway pressures include:

• Asynchronous breathing
  
• Low compliance (high peak and plateau pressures):
  - endobronchial intubation
  - pulmonary pathology
  – pneumothorax
  - hyperinflation: dynamic, obstructed PEEP valve or expiratory port, excessive PEEP
  - ascites
  
• Increased system resistance (high peak pressures only):
  - obstruction to flow in circuit, tracheal tube
  - malplaced ETT
  – bronchospasm
  - aspiration/secretions
  

Mechanical ventilation in Intensive Care