Mechanical Ventilation Advanced - Auto PEEP, Breath Stacking, Air Trapping | Clinical Medicine

In this podcast we dive into the topic of AutoPEEP, also known as breath stacking or air trapping or intrinsic PEEP as related to mechanical ventilation. Better understand these complex but important concepts!

Mechanism of Auto PEEP

Causes of Auto PEEP

Complications of Auto PEEP

Diagnosis, Management, and Scalars

Auto PEEP occurs when a patient on mechanical ventilation does not have enough time to fully expire their tidal volume before the ventilator gives another breath. This leads to a small amount of tidal volume being retained in the lungs with each breath and over time this builds up creating Auto PEEP. The breaths are "stacking" on top of each out or the air is being "trapped" in the lungs creating intrinsic PEEP! (see what I did there?)

Auto PEEP can occur for a number of reasons. The most common include a high minute ventilation. If you are administering huge tidal volumes or if you have set the respiratory rate quite high, sometimes a patient will not have enough time to fully expire each breath. Lung compliance contributes and more commonly when a patient has high airway resistance, such as with COPD or asthma.

Auto PEEP can cause hypotension as the intrathoracic pressures increases decreasing venous return. It also can cause ventilator induced lung injury, patient ventilator dyssynchrony, and increased dead space ventilation.

It is most formally diagnosed with an expiratory hold maneuver, but you can look at the pressure, flow, and volume scalars to assist in diagnosis. It also tends to cause a high plateau pressure. Manage it by treating the underlying illness, increasing the amount of a time a patient has to expire, and if it gets severe disconnecting the patient from the ventilator.

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YouTube Video:

https://www.youtube.com/watch?v=gcGvPiGd7nc