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

  • Laurent Brochard


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].


Chronic Obstructive Pulmonary Disease Assisted Ventilation Inspiratory Effort Control Mechanical Ventilation Dynamic Hyperinflation 
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© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Laurent Brochard
    • 1
    • 2
    • 3
    • 4
  1. 1.Réanimation Médicale, Hôpital Henri MondorUniversité ParisCréteilFrance
  2. 2.Medical Intensive Care Unit, Assistance Publique-Hôpitaux de ParisHenri Mondor–Albert Chenevier Teaching HospitalCréteilFrance
  3. 3.INSERM Unité 955, IMRBCréteilFrance
  4. 4.Paris XII UniversityCréteilFrance

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