UMEM Educational Pearls

PEEP in the Intubated Obese Patient

  • Obesity has numerous adverse effects on the respiratory system, most notably a reduction in lung volumes.
  • The reduction in lung volumes (i.e., FRC) often result in airway closure and atelectasis.
  • The application of PEEP in the mechanically ventilated patient helps maintain alveolar patency by preventing derecruitment.
  • Importantly, the typical initial PEEP setting of 5 cm H2O is insufficient for many ventilated obese patients.
  • Pearl: In the ventilated obese patient start with an initial PEEP of 10-15 cm H2O.

References

De Jong A, et al. How to ventilate obese patients in the ICU. Intensive Care Med. 2020; 46:2423-35.