Positive End Expiratory Pressure in Adults

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Abstract
DURING the last 15 years, positive end expiratory pressure (PEEP) has been increasingly used in the therapy for some forms of acute respiratory failure in adults. Effective use of PEEP, however, is predicated on an understanding of pulmonary mechanics, cardiopulmonary physiology, and the pathophysiology of the diseases to which this therapy is applied. Respiratory Mechanics At the end of tidal volume exhalation in a spontaneously breathing person, the amount of air remaining in the lung, the functional residual capacity (FRC), is determined by two opposing factors: (1) the tendency of the chest wall to expand, and (2) the tendency of the lung to collapse (elastic recoil). These two opposing factors cause the pressure in the pleural space to be negative (≈-5 cm H2O). Tidal volume ventilation then begins at FRC with inspiratory musculature causing the volume of the thorax to increase, resulting in a more negative intrapleural pressure;

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