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