Diagnosis & Management of Auto-PEEP in Obstructive Pulmonary Disease


  • Intrinsic PEEP is also known as auto-PEEP or PEEPi
  • Asthma / COPD patients have higher levels of PEEPi and are  susceptible to dynamic hyper-inflation (DH) or “breath stacking”


  • Slow filling of manual ventilator bag
  • Capnography trace that does not reaching plateau
  • Expiratory flow not reaching zero in flow-time/volume graph
  • Measure intrinsic PEEP (PEEPi)

DH increases intra-thoracic volume and results in:

  • increased inspiratory work to trigger the vent
  • increased risk of barotrauma
  • decrease venous return, preload, cardiac output resulting in decreased cardiac output

Management – allow more time for exhalation with less breath stacking

  • Treat reversible factors (bronchospasm, secretions)
  • Reduce RR, decrease I:E ratio (typically to 1:3 – 1:5)
  • Consider use of external PEEP (will decrease work to trigger vent)
  • If patient has hypotension, disconnect circuit from ETT to observe prolonged exhalation and resolution of hypotension (don’t forget to involve RT and reconnect promptly!)


Leave a Reply

Your email address will not be published. Required fields are marked *