1. Special Procedure What is PEEP ? Positive End Expiratory Pressure Where does PEEP have a positive effect? Increased alveolar recruitment What could be compromised with PEEP? Poor venous return Negative influence on heart What is PEEPi ? Intrinsic PEEP A measurement, in pressure, of trapped volume in lungs High PEEPi is a result of patient illness and patient/ventilator interaction

2. Trapped Volume During Mandatory Ventilation Time (I : E ratio) Insp. time - must be adequate for delivery of desired V TI Exp. time - must be long enough to eliminate V TE Insufficient expiratory time means trapped volume

3. PEEP i = Auto PEEP = Alveolar PEEP Lung status information available in every mode Auto stop of measurements if pressure increases (mes. time 1) or flow becomes zero (mes. time 2) Maximum measuring times for paediatric and adults PEEPiadultmax.3 s paediatricmax.1.5 s V Trap adultmax. 7 s paediatricmax.3.5 s Improved monitoring of inverse ratio ventilation (IRV) PEEPi

4. Heart and Lung poor Compliance contributes to poor gas exchange pressure is in the lungs pressure is in the heart They work against each other. PEEPi increases pressure against the heart.

5. Where Does Measurement of PEEPi Take Us? Safer ventilation Improved alveolar recruitment Improved ventilation comfort for asthmatics and COPD patients