Abstract
The mechanisms generating intrinsic or auto-positive end-expiratory pressure (PEEP) during controlled mechanical ventilation in a relaxed patient also occur during spontaneous breathing or when the patient triggers the ventilator during an assisted mode [1, 2]. These include an increased time constant for passive exhalation of the respiratory system, a short expiratory time resulting from a relatively high respiratory rate and/or the presence of expiratory flow limitation. Whereas dynamic hyperinflation and intrinsic or auto-PEEP may have haemodynamic consequences, this is not frequently a major concern in spontaneously breathing patients or during assisted ventilation because the spontaneous inspiratory efforts result in a less positive or more negative mean intrathoracic pressure than during controlled mechanical ventilation. The main consequence of dynamic hyperinflation during spontaneous and assisted ventilation is the patient’s increased effort to breathe and work of breathing [1, 2].
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Brochard L (2002) Intrinsic (or auto-) PEEP during controlled mechanical ventilation. Intensive Care Med 28:1376–1378
Rossi A, Polese G, Brandi G, Conti G (1995) Intrinsic positive end-expiratory pressure (PEEPi). Intensive Care Med 21:522–536
Coussa ML, Guérin C, Eissa NT, Corbeil C, Chassé M, Braidy J, Matar N, Milic-Emili J (1993) Partitioning of work of breathing in mechanically ventilated COPD patients. J Appl Physiol 75:1711–1719
Ranieri VM, Mascia L, Petruzelli V, Bruno F, Brienza A, Giuliani R (1995) Inspiratory effort and measurement of dynamic intrinsic PEEP in COPD patients: effects of ventilator triggering systems. Intensive Care Med 21:896–903
Smith TC, Marini JJ (1988) Impact of PEEP on lung mechanics and work of breathing in severe airflow obstruction. J Appl Physiol 65:1488–1499
Petrof BJ, Legaré M, Goldberg P, Milic-Emili J, Gottfried SB (1990) Continuous positive airway pressure reduces work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive pulmonary disease (COPD). Am Rev Respir Dis 141:281–289
Ranieri MV, Giuliani R, Cinnella G, Pesce C, Brienza N, Ippolito E, Pomo V, Fiore T, Gottried S, Brienza A (1993) Physiologic effects of positive end-expiratory pressure in patients with chronic obstructive pulmonary disease during acute ventilatory failure and controlled mechanical ventilation. Am Rev Respir Dis 147:5–13.
Younes M, Kun J, Webster K, Roberts D (2002) Response of ventilator-dependent patients to delayed opening of exhalation valve. Am J Respir Crit Care Med 166:21–30
Lessard MR, Lofaso F, Brochard L (1995) Expiratory muscle activity increases intrinsic positive end-expiratory pressure independently of dynamic hyperinflation in mechanically ventilated patients. Am J Respir Crit Care Med 151:562–569
Appendini L, Patessio A, Zanaboni S, Carone M, Gukov B, Donner CF, Rossi A (1994) Physiologic effects of positive end-expiratory pressure and mask pressure support during exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 149:1069–1076
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Brochard, L. (2009). Intrinsic (or auto-) positive end-expiratory pressure during spontaneous or assisted ventilation. In: Hedenstierna, G., Mancebo, J., Brochard, L., Pinsky, M. (eds) Applied Physiology in Intensive Care Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-01769-8_2
Download citation
DOI: https://doi.org/10.1007/978-3-642-01769-8_2
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-01768-1
Online ISBN: 978-3-642-01769-8
eBook Packages: MedicineMedicine (R0)