PEEP phobia?

[mbarbaglia]

Some in Nicu VG set to 4-5 ml / kg and rose PEEP to improve oxygenation to get off to FiO2 of 0.30. What steps cmH2O for PEEP and times change you? Max value for PEEP? thanks

[Skysurfer]

Please check following literature: Tobin MJ. NEJM 344:1986-96, 2001

The ARDS Network Study has given some info about Peep Trials as follows

FiO2 / PEEP Combination

FiO2: 0,3 0,4 0,4 0,5 0,5 0,6 0,7 0,7 0,7 0,8 0,9 0,9 0,9 1,0

PEEP: 5 5 8 8 10 10 10 12 14 14 14 16 18 18-24

You have to titrate the peep under normal lung volumes 4-6ml/kg

Pmax <30cmH20

titration of peep until normal PaO2 and Pco2 values are achieved

hope that helps...

Norbert

[Stefan Johansson]

I think Martin Keszler has coined "PEEPophobia" - I have heard him lecture about the adverse effects of too low PEEP enough times to adopt the concept of "optimal lung volume". I think the take-home-message from Keszler makes a lot of sense. Sufficiently high PEEP helps to maintain patency of the smallest airways, reduces atelectasis, improves ventilation/perfusion matching.

I am sorry to say that we do not use the volume guarantee mode (we use Leoni-ventilators that lack true VG). We generally use PEEPs of 4-5 cm when the infants are on MV. When we use HFOV we use a lung-recruitment strategy where we increase PEEP/CDP until we feel oxygenation is good.

[JACK]

We use a PEEP of 4.5 - 6cm for RDS and PEEP of 3 cm for MAS.

We often rely on the Chest Xray to guide us with setting the PEEP. Underinflated lungs and alveolar atelectasis drive up the PEEP.

Hyperinflated lung fields and clear lung fields drive down the PEEP.

[ammar]

we use in case of alveolar desease PEEP with a value that depends directly to FiO2. So if patient O2 requirement is high, >40-45%, you need to use PEEP>5 cm H2O, and in neonate (preterme, Weight dependent) you can use 7-8 cm H2O. When you have not Lung desease (PPHN....), PEP is Usually 0-2 cm H2O. you must control the effect of PEEP, 30 mn after change and without aspiration to make Sure that there is not ALS (PX, PM, PPC, IE or overdistension). Other thing, you must care to the hemodynamic effect of PEEP in newborn with hypotension.

[drgeojose]

the concept of optimal peep differs in different lung conditions,more for atelectatic lungs,can be counter checked with x ray for lung spaces,though dr wung has described the optimal peep of atleast 5 for all his cpap babies, i guess we can regulate with the case scenario, but it might be prudent to avoid overinflated lung,reduced venous return, barotrauma at one end and underinflation of lungs at the other