Today our topic of discussion is Special Positive Pressure.
Special Positive Pressure
Special Positive Pressure Ventilation Technique
Positive end expiratory pressure (PEEP): It is a mode of therapy used with mechanical ventilation where pressure during mechanical ventilation is maintained above atmosphere at the end of exhalation resulting in an increased functional residual capacity. Airway pressure is positive throughout the ventilator cycle. When use to treat patients with diffuse lung disease PEEP improves compliance, decreases dead space.
Uses: Used to increase the surface area to prevent collapse of alveoli and development of atelectasis. Used to decrease intrapulmonary shunt.
Advantages
Lower level of FiO, concentration of inspired oxygen is necessary with PEEP .It is helpful in reducing the transudation of fluid from the pulmonary capillaries in situations where pressure is increased as in left heart failure or when the alveolar capillary membrane is damaged as in adult respiratory distress syndrome Increased lung compliance resulting in decreased work of breathing.
Disadvantages
Due to the increased airway resulting in over distension of alveolt can result in decreased cardiac output due to decreased venous return The increased airway pressure can result in rupture of the alveoli which may cause pneumothorax or subcutaneous emphysema.
The decreased venous return stimulates the production of antidiuretic hormone thereby the urine output is reduced Monitoring of the patient on PEEP should include signs and symptoms of pneumothorax such as increased pulmonary artery pressure, decreased lung movement diminished breath sounds, and signs and symptoms of decreased venous return which includes decreased arterial pressure, decreased cardiac output and decreased urine output.
Continuous positive airway pressure (CPAP) It has the same physiological characteristics of PEEP. It provides positive airway pressure during all parts of respiratory cycle but refers to spontaneous ventilation rather than mechanical ventilation.
CPAP is delivered through ventilator circuit or through a separate CPAP circuit which does not require ventilator. It is indicated for patients who are capable of marinating adequate tidal volume but are not able to maintain tissue oxygenation.
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