UMEM Educational Pearls

PEEP in the Ventilated COPD Patient?

  • Patients with acute respiratory failure secondary to COPD often have dynamic hyperinflation and intrinsic PEEP (PEEPi).
  • Both dynamic hyperinflation and PEEPi adversely effect pulmonary mechanics, markedly increase the work of breathing, impair respiratory muscle function, and can result in hemodynamic compromise.
  • It has traditionally been felt that the application of external PEEP in the intubated COPD patient may worsen hyperinflation.
  • Importantly, external PEEP has been shown to improve ventilator synchrony and decrease the work of breathing.
  • PEEPi is measured using an end-expiratory hold maneuver in a passive, relaxed patient.
  • External PEEP can then be set to approximately 70% of PEEPi, followed by frequent monitoring of plateau pressures in a volume-cycled ventilation mode.


Jubran A. Setting positive end-expiratory pressure in the severely obstructive patient. Curr Opin Crit Care. 2024; 30:89-96.