Treatment of mechanically ventilated patients with clinically significant intrinsic PEEP

lpm: liters per minute; PEEP: positive end-expiratory pressure; PIP: peak inspiratory pressure; Pplat: plateau pressure; RR: respiratory rate; Ti: inspiratory time; Vt: tidal volume; WOB: work of breathing.

*: Intrinsic PEEP can be measured using an expiratory pause on the ventilator, which provides a value. However, it is only accurate when the patient is paralyzed or has little abdominal and chest wall muscle engagement during exhalation. We do not encourage paralysis for this indication. If inaccurate measurements are suspected, we use clinical assessment, Pplat (on volume control), and ventilator graphics to assess the response.

¶: For patients on volume modes, a wide difference in measured PIP and Pplat supports the presence of intrinsic PEEP with airway resistance as the underlying etiology.

Δ: Reducing the respratory rate is typically performed first with or without reducing the tidal volume.

◊: These are estimated targets only.