Auto-PEEP in the Multisystem Injured Patient

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Abstract
Auto-PEEP (A-PEEP), unrecognized alveolar positive and expiratory pressure during mechanical ventilation, is an acknowledged hazard in patients with chronic obstructive lung disease. We evaluated 50 consecutive trauma patients for the presence of A-PEEP and its effect on hemodynamic stability. Injury Severity Scores (ISS) were 8 to 41 (21 ± 1); Revised Trauma Scores (RTS) ranged from 2.0 to 7.8 (6.2 ± 0.2). Mode of ventilation was assist control, inspiratory flow rates were 40 to 120 L/M (78 ± 2). A-PEEP, determined in the non-assisting patient by occluding the expiratory port at end exhalation, was present in 28 patients (56%) and ranged from 1 to 12 cm H2O (5.3 ± 0.4 cm H2O). Data segregated by A-PEEP versus no A-PEEP were as follows (Mean ± SEM).