Skip to main content

Intrinsic (or auto-) positive end-expiratory pressure during spontaneous or assisted ventilation

  • Chapter
  • First Online:
Applied Physiology in Intensive Care Medicine
  • 2547 Accesses


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

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD 149.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others


  1. Brochard L (2002) Intrinsic (or auto-) PEEP during controlled mechanical ventilation. Intensive Care Med 28:1376–1378

    Article  PubMed  Google Scholar 

  2. Rossi A, Polese G, Brandi G, Conti G (1995) Intrinsic positive end-expiratory pressure (PEEPi). Intensive Care Med 21:522–536

    Article  PubMed  CAS  Google Scholar 

  3. 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

    PubMed  CAS  Google Scholar 

  4. 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

    Article  PubMed  CAS  Google Scholar 

  5. 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

    PubMed  CAS  Google Scholar 

  6. 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

    PubMed  CAS  Google Scholar 

  7. 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.

    PubMed  CAS  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. 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

    PubMed  CAS  Google Scholar 

  10. 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

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Editor information

Editors and Affiliations

Rights and permissions

Reprints 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.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-01768-1

  • Online ISBN: 978-3-642-01769-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics