What Is Peep In Health And Safety

Personal emergency evacuation plans (PEEPS) | Occupational Health | University of Exeter What is a PEEP A PEEP is a plan for a person who may need assistance, for instance, a person with impaired mobility, to evacuate a building or reach a place of safety in the event of an emergency.

Who needs a PEEP
The key question to ask is “Can this person leave the building unaided in an emergency?”
If the answer is No, they need their own evacuation plan.
A PEEP may be needed for someone with an impairment or disability such as:

Mobility impairment
Sight impairment
Hearing impairment
Cognitive impairment
A medical condition or injury which might cause them to need assistance to evacuate safely.

Sometimes the requirement for a PEEP may be temporary for instance, someone who is using a wheelchair because of a broken leg or someone in the late stages of pregnancy.
IMPORTANT – the plan must not rely on the Fire and Rescue Service’s intervention to make the plan work.
Who’s responsibility is a PEEP

A manager is responsible for ensuring the safety of their staff. It is their responsibility to identify individuals who may require a PEEP and to implement the PEEP assessment. Full information can be found on the University of Exeter (please note, you will need to open the form in the desktop application and save the form to be able to edit it).

Who should carry out a peep?

How do I get a PEEP? – If you need assistance evacuating a building, even if this is only on a temporary basis, then you need to bring this to the attention of your line manager. Your line manager is responsible for working with you to complete your PEEP.

What are the two types of peep?

From Wikipedia, the free encyclopedia Positive end-expiratory pressure ( PEEP ) is the pressure in the lungs ( alveolar pressure ) above atmospheric pressure (the pressure outside of the body) that exists at the end of expiration, The two types of PEEP are extrinsic PEEP (PEEP applied by a ventilator) and intrinsic PEEP (PEEP caused by an incomplete exhalation).

What is a peep in regards to emergency response?

A PEEP is a Personal Emergency Evacuation Plan. It is an ‘escape plan’ for individuals who may not be able to reach an ultimate place of safety unaided or within a satisfactory period of time in the event of any emergency.

What is normal PEEP pressure?

Inspiratory recruitment – During inspiration, if the applied pressure is sufficient, previously collapsed pulmonary units will open and inflate. We have then to understand: first, why and how the units are collapsed; second, where are they located; finally, how the opening pressures actually work.

A collapsed unit may be defined as a pulmonary unit where the gas content is near zero or nil. The first kind of collapse is due to the small airways collapse, primarily because of the increased lung weight; this “squeezes” the gas out of the unit and closes the small airways. Some gas is left behind the collapsed airway (gas content near zero). The second kind of collapse is due to the complete reabsorption of the gases from the pulmonary unit. This occurs whenever and wherever a tributary airway stays closed throughout the entire respiratory cycle. During ARDS, other pulmonary units may present as a gasless, but are “consolidated” instead of collapsed. These units are usually filled with liquid/solid material originating from the disease process leading to ARDS. In practice, collapsed and consolidated units may be differentiated only after a given “maximal” opening pressure is applied;
The number of units in which the collapse is primarily due to the gravitational forces increases when the superimposed pressure (i.e., the lung mass times the vertical height) increases ( 22 – 24 ). It must be noted, however, that the units at a given iso-gravitational plane aren’t necessarily all open or all closed, as local phenomena of interaction between contiguous units may prevent or favor their closure. Note that the unit collapsing at end-expiration remains “loose” if they reopen and receive gas during the next inspiration, otherwise they become “sticky” atelectasis with time. While the most frequent loose atelectasis follows a quite definite spatial orientation (from non-dependent to dependent lung) ( 25, 26 ), the reabsorption atelectasis arises both in the most dependent lung regions (where the inspiratory pressure isn’t sufficient to open the gravitational dependent collapsed units) and wherever an airway obstruction occurs for non-gravitational reasons;
To open a given unit the applied pressure must overcome at least four distinct forces (ignoring the gas movement):
1. The surface tension forces ( 27 ). These are likely lower in the “loose” atelectasis, where some gas is still present, than in the “sticky” atelectasis, where all the water molecules are in contact with each other;
2. The pressure superimposed to that given unit ( 22, 23 );
3. The pressure likely due to the interaction between neighboring units collapsed in an iso-gravitational plane ( 28 );
4. The pressure needed to lift up the chest wall at the same volume to which the lung has been inflated ( 24 ).

Taking into account all these phenomena may contribute in understanding the behavior of the opening pressures. In Figure 1 we present an inspiratory recruitment-airway pressure curve measured in 34 ARDS patients. As shown, the shape is sigmoidal ( 29, 30 ), which, expressed as opening pressure distribution, results in a Gaussian curve. The diagram shows a possible pressure-recruitment curve. The values have been taken from Cressoni et al. ( 28 ). The point on the inspiratory limb (solid red line) at pressure of ~30 cmH 2 O and at ~18 cmH 2 O represents the average inspiratory recruitment starting from 15 and 5 cmH 2 O PEEP respectively.

The two points at ~15 and ~5 cmH 2 O along the expiratory limb (dotted black line) represent the recruitment measured at those levels of PEEP. As shown, the amount of tissue undergoing recruitment and derecruitment between end-inspiratory and end-expiratory points is similar at 5 and 15 cmH 2 O PEEP.

The tidal volume was the same at the two PEEP levels. The upper two points are hypothetical. See text for details. PEEP, positive end-expiratory pressure. Opening pressure = compressive forces (10–15 cmH 2 O) + surface tension (15–20 cmH 2 O) + chest wall (5–10 cmH 2 O) = 30–45 cmH 2 O As shown, at 45 cmH 2 O, most of the possible recruitment should be accomplished in the majority of the patients.

What does PEEP stand for in the workplace?

Who needs a PEEP
The key question to ask is “Can this person leave the building unaided in an emergency?”
If the answer is No, they need their own evacuation plan.
A PEEP may be needed for someone with an impairment or disability such as:

Mobility impairment
Sight impairment
Hearing impairment
Cognitive impairment
A medical condition or injury which might cause them to need assistance to evacuate safely.

Sometimes the requirement for a PEEP may be temporary for instance, someone who is using a wheelchair because of a broken leg or someone in the late stages of pregnancy.
IMPORTANT – the plan must not rely on the Fire and Rescue Service’s intervention to make the plan work.
Who’s responsibility is a PEEP

How do you conduct a peep?

A PEEP should contain details of the necessary escape route(s). Clear unobstructed gangways and floor layouts should be considered at the planning stage. It is especially important to ensure that security devices on doors, etc, are all able to be operated by the evacuating persons.

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Who are peep forms for?

PEEP’s are individualised emergency plans designed for mobility impaired occupants who may require assistance during an emergency.

How do you measure PEEP?

Measuring AutoPEEP – All Hamilton Medical Ventilators have the unique capability of showing AutoPEEP as a monitoring parameter on a breath-by-breath basis. It is calculated using the LSF method applied to the entire breath ( Iotti GA, Braschi A, Brunner JX, et al.

Respiratory mechanics by least squares fitting in mechanically ventilated patients: applications during paralysis and during pressure support ventilation.
Intensive Care Med.1995;21(5):406-413.
Doi:10.1007/BF01707409 3 ).
However in special circumstances for example when severe dynamic hyperinflation is present, the AutoPEEP calculated by LSF can underestimate the actual AutoPEEP.

In these cases it can be obtained by performing an expiratory hold maneuver. Measuring the total PEEP with an expiratory hold maneuver (see Figure 2 below): Ensure the Paw waveform is displayed.

Open the Hold window.
Wait until the Paw waveform plot restarts from the left side.
Wait for the next inspiration.
Then select Exp hold, Wait for 3 to 5 seconds, then select Exp hold or press the P&T knob again to deactivate the hold maneuver and close the window.
After the maneuver, the Hold window closes, and the freeze function is activated automatically.
Measure the total PEEP by examining points after flow reached zero on the pressure curve with the cursor.
Calculate AutoPEEP by subtracting extrinsic PEEP from the total PEEP.

What is PEEP and why is it important?

Positive end expiratory pressure (PEEP), is a pressure applied by the ventilator at the end of each breath to ensure that the alveoli are not so prone to collapse. This ‘recruits’ the closed alveoli in the sick lung and improves oxygenation. So PEEP: Reduces trauma to the alveoli.

When should PEEP be used?

Function – Extrinsic PEEP can be used to increase oxygenation. By Henry’s law, the solubility of a gas in a liquid is directly proportional to the pressure of that gas above the surface of the solution. This applies to mechanical or noninvasive ventilation in that increasing PEEP will increase the pressure in the system.

This, in turn, increases the solubility of oxygen and its ability to cross the alveolocapillary membrane and increase the oxygen content in the blood.
Extrinsic PEEP also can be used to improve ventilation-perfusion (VQ) mismatches.
The application of positive pressure inside the airways can open or “splint” airways that may otherwise be collapsed, decreasing atelectasis, improving alveolar ventilation, and, in turn, decreasing VQ mismatch.

The application of extrinsic PEEP will, therefore, have a direct impact on oxygenation and an indirect impact on ventilation. By opening up airways, the alveolar surface increases, creating more areas for gas exchange and somewhat improving ventilation.

Nevertheless, extrinsic PEEP should never be used for the sole purpose of increasing ventilation.
If a patient needs to clear CO2 by improving ventilation, he should receive some level of pressure support for his ventilation, either via BPAP or invasive ventilation.
Extrinsic PEEP also significantly decreases the work of breathing.

This is especially important for stiff lungs with low compliance. In intubated patients with low compliance, work of breathing can represent an important part of their total energy expenditure (up to 30%). This increases CO2 and lactate production, both of which may be problems of their own.

What happens if PEEP is high?

Editor’s key points –

• Positive end-expiratory pressure is widely used in mechanically ventilated patients with the acute respiratory distress syndrome (ARDS), but the effect of PEEP on tissue oxygen delivery is not known. • The authors investigated the effects of PEEP on tissue oxygen delivery in ARDS. • Increasing PEEP increased arterial oxygen tension but decreased tissue oxygen delivery.

The incidence of acute respiratory distress syndrome (ARDS) has been estimated at ∼70 per 100 000 patients yr −1, 1, 2 with a lethal outcome in 55% of patients.3 The global burden of the disease was estimated as 5.5 million patients yr −1 requiring intensive care unit admission and mechanical pulmonary ventilation.4 The rationale for the application of PEEP during mechanical ventilation of the lungs of patients with ARDS is to prevent alveolar collapse, reducing injurious alveolar shear stresses and improving ventilation–perfusion matching, and thus, arterial oxygenation.5, 6 Studies investigating the effect of PEEP have consistently shown an improvement in oxygenation and pulmonary compliance.5, 7, 8, 9, 10 Survival benefit was seen in patients when PEEP was assigned based on oxygen requirements in combination with low vs traditional tidal volume ventilation, 11 and some risk reduction was shown in a pooled subgroup analysis when patients were stratified based on ARDS severity.12 Despite this, the results of four large studies examining high-PEEP strategies in ARDS have demonstrated an equivocal effect on mortality, 13, 14, 15, 16 confirmed after meta-analysis.12 Consequently, it is unclear who might benefit from the application of PEEP; clinical investigation has, to date, failed to provide a conclusive answer.

High levels of positive airway pressure throughout the respiratory cycle have the potential to impair cardiac performance, manifested as a reduced cardiac output.17, 18, 19, 20 This is a result of increased right ventricular afterload, reduced left ventricular preload, and reduced biventricular compliance.21 It is credible that PEEP-induced reduction in cardiac output may outweigh the benefit of improved arterial oxygenation, resulting in reduced organ oxygen delivery ( D O 2 ), and this was suggested by the early work by Suter and colleagues 22 examining the effect of PEEP on lung compliance.

Given the difficulty of accurately measuring oxygen delivery in vivo, arterial oxygenation is the usual, clinical target for ventilatory optimization; thus, we may remain unaware of the quantitative effect that PEEP might have with respect to oxygen delivery.

What happens when PEEP is too high?

The Pre-brief Upon responding to a rapid response, you notice your patient is in respiratory failure with an SPO2 in the 70’s. You place them on a non-rebreather mask and prepare for intubation. Once intubated, you transport the patient to the ICU and place them on the ventilator.

A tidal volume of 6cc/kg is set along with an FIO2 of 100%. But what is the appropriate PEEP? What is PEEP? It is one of the basic settings dialed in when a patient is on the ventilator. Positive end-expiratory pressure (PEEP) is a critical asset used in conjunction with mechanical ventilation. Typically, 5cmH2O is used unless hypoxemia or ARDS is present.

PEEP is the pressure maintained in the airways at end-expiration above atmospheric pressure. Extrinsic PEEP can prevent alveolar collapse, thus improving oxygenation and FRC. It also increases the alveolar surface, which will help enhance ventilation-perfusion (VQ) mismatch. What is Optimal PEEP? Optimal PEEP is when oxygenation is maximized, there is minimal end-expiratory atelectasis and minimal end-inspiratory over-distention. But how do you determine optimal PEEP? Many clinicians have difficulty trying to distinguish between overdistention and under-inflation while trying to determine the best method in obtaining optimal PEEP.

ARDS Net PEEP/FiO2 table.

Titrate PEEP according to maximum compliance. PEEP is increased in increments. Set PEEP slightly above the lowest inflection point of the pressure-volume curve. The lowest inflection point reflects the pressure at which collapsed alveoli are opening.

Setting PEEP by best oxygenation using higher than standard settings, which is usually set between 12-15cmH2O. SvO2 monitoring, transpulmonary pressure calculated from an oesophageal balloon, electrical impedance tomography, and sequential CT scans are other ways.

Recently we as clinicians hear a lot about driving pressures. I use and obtain driving pressures every morning as a tool to determine optimal PEEP for my patients. So what is Driving Pressure? Driving pressure is the plateau airway pressure minus the PEEP set.

It is determined by the set tidal volume and the static compliance of the lungs. During volume control ventilation, an inspiratory pause greater than or equal to three seconds gives the most accurate plateau pressure. Driving pressure simplifies optimization of mechanical ventilation and PEEP. Safe ventilation occurs with a plateau less than 30cmH2O and a driving pressure under 15cmH2O.

Obtain plateau pressures at different levels of PEEP, changing PEEP in increments of two to determine optimal PEEP. Make sure to wait for one to five minutes to recheck plateau pressures after every PEEP change.

There are numerous methods that clinicians and facilities use to find optimal PEEP, such as the ones we have been practicing, along with some new approaches such as using an esophageal balloon to monitor chest wall pressures. With every method comes its positives and faults, and no one way is the best. How one decides to find optimal PEEP is left up to the provider and the patient’s presentation.

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The Debrief

Finding the correct setting for PEEP can lead to improved outcomes in ventilated patients. Driving pressures is a simplistic way of finding optimal PEEP. Check out this post on driving pressures and PEEP titration by Dr. Matt Suiba.

What is the maximum PEEP?

Conclusion – Under controlled conditions, higher levels of PEEP are well tolerated. PEEP of 29 appears to be the highest tolerated PEEP in our patient. We noted an initial rise in blood flow across all cardiac valves followed by a gradual decline. Studies are needed to investigate the immediate effect and long-term impact of PEEP on cardiopulmonary parameters and clinical outcomes.

Can you have a PEEP of 0?

Introduction – Critically ill patients with artificial airways have shown changes in mucociliary clearance with the accumulation of secretions due to sedation, depression of the cough reflex, high concentrations of oxygen, inadequate cuff pressure, inflammation, and mucosal trauma.1 – 4 Airway aspiration is often necessary to maintain alveolar permeability and to prevent respiratory tract infection.5 According to the guidelines of the American Association for Respiratory Care (AARC), 6 this procedure may result in numerous side effects, such as risks and complications for developing hypoxia/hypoxemia due to reduced level of tissue oxygenation ( ), decreased arterial oxygen saturation ( ), and peripheral oxygen saturation ( ); 7 – 11 tissue trauma to the tracheal or bronchial mucosa with hemorrhagic secretion; 7 increased microbial colonization of lower airways; 9 decrease in dynamic compliance 10 – 12 and functional residual capacity; 13 atelectasis; 1, 9 bronchoconstriction; 14 changes in cerebral blood flow and increased intracranial pressure; vasovagal reactions; changes in blood pressure and heart rate; 7 – 16 cardiac arrhythmias; 15 low tidal volume; 10, 17 – 19 and elevated carbon dioxide levels in the blood ( ).11, 17 Use of a closed suction system is suggested for adults with high or PEEP at risk of lung de-recruitment and for neonates.6 Advantages of a closed suction system compared with an open system include continuous mechanical ventilation, reduced hemodynamic impairment, shorter hospital stay, and reduced costs for patients and the health care system. include appropriate catheter size, depth and time of suctioning, pressure setting, as well as routinely avoiding saline instillation and manual hyperinflation.8, 17, 18, 20 – 23 Hyperoxygenation is a method used to increase above basal levels, and 100% hyperoxygenation has been the most widely used method.6, 16 Manual hyperinflation and ventilator hyperinflation are 2 physiotherapy procedures used to remove secretions. Manual hyperinflation with manual chest compression, also known as bag squeezing, was first described in 1968 by Clement and Hübsch.24 This physiotherapeutic technique aims to improve oxygenation, clear bronchial secretions, and achieve alveolar re-expansion. Ventilator hyperinflation was originally described by Berney and Denehy 25 in 2002 as an alternative to manual lung hyperinflation, and it has been adopted to achieve the same purposes. Based on the goal to increase expiratory air flow to remove secretions, studies have shown that pulmonary secretion removal depends not only on high expiratory flows, but also on the presence of an expiratory flow bias, ie, on the peak expiratory flow being higher than the peak inspiratory flow generated in the airways.26 Furthermore, Volpe et al 27 reported that the most significant threshold for expiratory flow bias to move secretion toward the glottis, for human conditions, is the difference between peak expiratory flow and peak inspiratory flow being > 33 L/min. The effects of 0 PEEP on lung compliance, 4, 28, 30 gas exchange, 4, 28 – 30 tidal volume, 30 and hemodynamic repercussions 4, 28, 29 have also been analyzed. This technique consists of imposing a gradual PEEP increase to 15 cm H 2 O followed by an abrupt PEEP reduction to 0 PEEP in association with a manual bilateral thoracic compression to potentiate the increase of expiratory air flow, limiting the peak pressure to 40 cm H 2 O.4, 28 – 30 The ventilator hyperinflation with increased volume or with 0 PEEP was similar to manual hyperinflation in terms of the bronchial secretion removal, oxygenation, and with insignificant hemodynamic repercussions.4, 28, 29, 31 The 0 PEEP technique appears to be safe, without alterations of hemodynamic variables, even in post-cardiac surgery patients.4 However, there have been few studies investigating using the 0 PEEP method to prevent hypoxemia or evaluating its impact on ventilation, whether associated with pre-oxygenation or not. Study designs involving ventilator hyperinflation are quite different, and the routine use of ventilator hyperinflation as well as the need for 100% hyperoxygenation are still debatable clinical issues. Previous studies have reported that = 1.0 should be the method of choice to prevent lower levels of or, especially during open endotracheal suctioning, as recommended by the latest guidelines of the AARC.16, 32, 33 However, other studies suggest the evaluation of the need for hyperoxygenation with = 1.0, considering that the delivery of low or no oxygen was able to prevent hypoxemia during open endotracheal suctioning.11, 34 – 39 Although O 2 was delivered for a short period of time, it is known that exposure to = 1.0 in humans produces toxic effects that can occur by reabsorption atelectasis, hyperoxic hypercapnia, bronchial and epithelial damage, decreased effectiveness of the ciliary epithelium, and bactericidal bronchial function.40 Respiratory markers of oxidative stress were observed in healthy volunteers, 41 while hyperoxygenation with 28% above baseline was delivered for 30 min.41 Oxidative damage was also detected in the lungs of rats exposed to 100% hyperoxygenation for 10 min.42 Hyperoxygenation combined with hyperinflation has been the most commonly used technique for the prevention of the adverse effects caused by open endotracheal suctioning and is well documented in the literature.32 However little is known about the effects of or 0 PEEP + 0.20 may maintain adequate and in open endotracheal suctioning without = 1.0 and the loss of lung volume. The aim of this study was to investigate the behavior of and in open endotracheal suctioning using 0 PEEP baseline and 0 PEEP + 0.20 in critically ill subjects on mechanical ventilatory support.

What is the PEEP setting for CPR?

Discussion – When lung compliance is poor such as in patients with pneumonia or bronchiolitis or when there is excess lung fluid for example with pulmonary edema, the critical closing pressure is increased, and lungs become more likely to collapse. During mechanical ventilation, by maintaining the PEEP above the critical closing pressure, alveolar collapse can be prevented,

Through a complex series of cardiopulmonary interactions, PEEP can potentially have a direct impact on CO. The blood in the venous system relies on the pressure difference generated by the venous blood, the mean systemic pressure, and the right atrium to promote the forward flow of blood back to the heart.

This difference between the mean systemic pressure and the right atrial pressure is the driving force for the preload, When PEEP is used, the increase in alveolar pressure is transmitted to the entire thorax, potentially increasing the right atrial pressure and thereby reducing the pressure difference between the mean systemic pressure and the right atrial pressure.

If the decrease in this pressure gradient is significant enough, it can result in decreased venous return to the heart, decreasing cardiac output,
The exact impact that this effect has is questionable, as a study by Jellinek et al.
Demonstrated that positive pressure increases both the right atrial pressure as well as the mean systemic pressure proportionally, resulting in no change in the mean systolic pressure-right atrium pressure gradient,

The use of too much PEEP can over-distend alveoli resulting in mechanical compression of the pulmonary capillaries, increasing the right ventricular (RV) afterload. An increase in the RV afterload can over-distend the RV, causing bowing of the ventricular septum into the left ventricular (LV), thereby further decreasing the volume of the LV, decreasing LV filling, and reducing CO.

On the left side of the heart, PEEP can shift the LV pressure-volume curve to the left, indicating a decrease in LV distensibility.
Thus, given that during CPR blood flow and venous return are already compromised as optimal CPR generates only 15% to 25% of normal CO, these effects of PEEP on CO can potentially diminish an already severely compromised CO.

Conversely, although an inappropriate amount of PEEP can have a detrimental effect on CO, using an appropriate amount of PEEP can potentially augment CO. Increasing the intrathoracic pressure can decrease the LV afterload, thereby improving the CO, especially in the setting of a poorly functioning LV.

Additionally, the correct amount of PEEP can optimize peripheral vascular resistance, thereby improving LV preload, The use of PEEP can potentially play a significant role in the ability to ventilate patients receiving CPR. Studies performed by the Cardiac Arrest and Ventilation International Association for Research Group demonstrated that in a cadaver model and a bench model of CPR, as well as in a clinical study analyzing capnograms of intubated patients receiving CPR, intrathoracic airway closure occurs in patients receiving CPR, which can limit ventilation.

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This airway closure was mitigated by the use of PEEP up to 10 cmH 2 O, which also caused some degree of ventilation to occur with the oscillations of air generated by the change in intrathoracic pressure that occurs during the compression and decompression phase of chest compressions,

The effect that using no PEEP potentially has on oxygenation and DO 2 to the tissues during CPR is also unknown.
There are currently no studies directly evaluating the effect of PEEP on CO during CPR.
There is also currently no consensus whether or not PEEP should be applied during CPR, and if used, how much PEEP should be applied.

The aim of this study was to evaluate the effect of PEEP on CO and DO 2 during CPR and to determine the ideal PEEP to maximize DO 2 by augmenting both CO and arterial oxygen concentration during CPR. The results of this study demonstrate that as PEEP is increased from 0 to 20 cmH 2 O, there is a significant decline in CO and DO 2,

Increasing the PEEP from 0 to 5 cmH 2 O results in a slight, statistically insignificant, decrease in CO, and increase in DO 2,
Further increases in PEEP to 10 cmH 2 O and above result in significant drops in CO.
Even compared with PEEP of 5 cmH 2 O, PEEP of 10 cmH 2 O showed a significant decline in CO.

For DO 2, compared with both PEEP of 0 and 5 cmH 2 O, once PEEP 15 cmH 2 O and higher is reached, there is a statistically significant drop in DO 2, In evaluating the effect of PEEP on PaO 2 during CPR, as PEEP is increased from 0 to 20 cmH 2 O, there is a significant increase seen in PaO 2,

Compared with a PEEP of 0 cmH 2 O, PEEP of 5, 10, and 15 cmH 2 O all had significantly higher PaO 2, Compared with PEEP of 5 cmH 2 O, only PEEP of 20 cmH 2 O had a significantly higher PaO 2, Using the Gaussian mixture model on adjusted means of CO and DO 2, there were three groups of homogeneous PEEP that were identified: 0–5, 10–15, and 20 cmH 2 O.

PaO 2 was not included in this analysis because even the lowest PEEP had a PaO 2 of 154, which is physiologic, representing an oxygen saturation of 100% and is likely adequate for CPR. In addition, the importance of PaO 2 is likely to be in the amount of oxygen delivered to the tissues during CPR, making DO 2 the more important variable.

Based on these results, assuming that the lungs are not acutely ill or poorly compliant, our results demonstrate that the 0–5 cmH 2 O PEEP group provides optimal CO and DO 2, with PEEP of 5 cmH 2 O providing the highest DO 2 overall, with an insignificant difference in CO between PEEP of 0 cmH 2 O and 5 cmH 2 O.

Thus, based on these results, it appears that PEEP of 5 cmH 2 O would be the optimal PEEP for ventilating patients during CPR. This study has a number of limitations. Most CPR studies are done on animals or other non-human models, and the porcine model is commonly used as a model for cardiac arrest because the physiology approximates that of humans,

However, it has to be acknowledged that there are differences in cardiovascular physiology between humans and pigs, such as different thorax geometry, which makes it an imperfect model for CPR physiology in humans. Also, the outcomes in this study are meant to evaluate cardiovascular parameters during CPR, with the goal of optimizing organ perfusion during CPR.

However, there is no evidence that following the conclusions in this study will directly lead to a better outcome in cardiac arrest patients. However, we do feel that to give providers the best chance at successfully resuscitating a patient, CPR must be optimized, and adjusting the PEEP to achieve optimal oxygen delivery is a potential area of optimization.

Ideally, these findings should be verified with a proper trial in humans; however, such a trial may be extremely difficult to design and implement. Although CPR is not typically performed with patients on a ventilator, PEEP adjustments can be made through the PEEP valve on a bag-valve-mask device. Finally, the goal of this study was to isolate the effect of PEEP on CO.

To accomplish this, slight adjustments were made to optimize physiologic parameters, such as allowing the animal to tolerate 60 min of CPR, which is not typically done when performing CPR on humans. For example, the respiratory rate was higher than the 10 breaths per minute currently recommended during continuous compression CPR to achieve and maintain a physiologic pH prior to and during CPR.

Along the same lines, the decision was made to maintain the animal on each PEEP level for 9 min, with 1 min in between to draw the arterial blood gas and reconnect cardiac output monitor to maintain the entire duration of CPR less than 1 h. We felt that if the compressions were to continue for more than an hour, the animals would be less stable for the final PEEP levels, which would introduce another variable into the equation.

By keeping the total compression time less than 1 h, we felt that the animal would be able to tolerate the entire course of compressions, whereas extending the overall time of compressions would have risked greater instability towards the end, compared with the beginning.

Using a two-way analysis of variance paradigm for the statistical analysis took into account PEEP level as well as time duration in the final analysis.
If the animals were unstable for the final PEEP levels, this would have added an additional variable that would have been difficult to account for.
In addition, after initiating cardiac arrest and during the 60 s prior to initiation of chest compression, the pigs were ventilated using a PEEP of 5 cmH 2 O to avoid alveolar collapse prior to the implementation of the study protocol, despite this differing from what occurs in typical cardiac arrest patients, who are not receiving PEEP when they go into cardiac arrest.

We feel that these do not detract from the results of this study, as the goal of the study is to look at the effect PEEP has on CO, which this study certainly does.

What are PEEP expectations?

Expectations (previously known as Overpopulation ) increase as the number of Peeps on the island increases. It provides a negative modifier to each Peep’s happiness, It cannot be removed, instead offset by providing the Peeps with happiness-boosting items, such as Tea, Fountains and Luxuries,

What does PEEP mean in 5s?

It’s also known as a ‘PEEP’ Concept which means ‘ Place for Everything, Everything in its Place. Here in this concept, the location of each item needs to be fixed as per its frequency of use.

What is PEEP NHS?

Personal Emergency Evacuation Plan Checklist – PEEP 1.

What does PEEP stand for UK?

Personal Emergency Evacuation Plan (PEEP) Aim. The aim of a PEEP is to provide people who cannot get themselves out of a building unaided with the necessary information and assistance to be able to manage their escape to a place of safety and to ensure that the correct level of assistance is always available.

What does peeps mean in the UK?

/piːps/ people or friends : He’s gone out with his peeps. SMART Vocabulary: related words and phrases. Friends, acquaintances & contemporaries.

Is a PEEP of 10 bad?

Increasing PEEP to 10 and higher resulted in significant declines in cardiac output. A PEEP of 15 and higher resulted in significant declines in oxygen delivery. As PEEP was increased from 0 to 20, PaO 2 increased significantly.

What is a high PEEP?

OVERVIEW – Positive End-Expiratory Pressure (PEEP) is the maintenance of positive pressure (above atmospheric) at the airway opening at the end of expiration. PEEP acts to distend distal alveoli, assuming there is no airway obstruction.

PEEP is routinely used in mechanical ventilation to prevent collapse of distal alveoli, and to promote recruitment of collapsed alveoliHow to optimise PEEP is a controversial topic, but should involve (1) optimisation of oxygenation and (2) minimisation of ventilator induced lung injury (VILI), and should should be individualised for a given patient”High” PEEP is used as part of an Open Lung Approach To Ventilation for Acute Respiratory Distress Syndrome (ARDS)In spontaneous ventilation using non-invasive ventilation (NIV), CPAP (continuous positive airway pressure) is analogous to PEEP, but the pressure applied is maintained throughout the respiratory cycle (during both inspiration and expiration).

Jack Gloop