PEEP role in ICU and operating room: from pathophysiology to clinical practice

M Vargas, Y Sutherasan, C Gregoretti, P Pelosi, M Vargas, Y Sutherasan, C Gregoretti, P Pelosi

Abstract

Positive end expiratory pressure (PEEP) may prevent cyclic opening and collapsing alveoli in acute respiratory distress syndrome (ARDS) patients, but it may play a role also in general anesthesia. This review is organized in two sections. The first one reports the pathophysiological effect of PEEP on thoracic pressure and hemodynamic and cerebral perfusion pressure. The second section summarizes the knowledge and evidence of the use of PEEP in general anesthesia and intensive care. More specifically, for intensive care this review refers to ARDS and traumatic brain injured patients.

Figures

Figure 1
Figure 1
Impact of PEEP on lung and hemodynamic and cerebral perfusion pressure. PEEP: positive end expiratory pressure, ICP: intracranial pressure, CPP: cerebral perfusion pressure, ARDS: acute respiratory distress syndrome, LV: left ventricular, RV: right ventricular, VR: venous return, CO: cardiac output, PVR: pulmonary vascular resistance and PPCs: Postoperative Pulmonary Complications.
Figure 2
Figure 2
Pressure-volume curve with lower and upper inflection points. According to PEEP level, the recruitment of collapsed alveoli could be set between the lower and the upper inflection points.

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