関: autoPEEP、intrinsic PEEP、intrinsic positive-pressure respiration

WordNet

speak in a hesitant and high-pitched tone of voice
make high-pitched sounds; "the birds were chirping in the bushes" (同)cheep, chirp, chirrup
appear as though from hiding; "the new moon peeped through the tree tops"
cause to appear; "he peeped his head through the window"
look furtively; "He peeped at the woman through the window"

PrepTutorEJDIC

(すき間などから)『のぞき見する』《+『through』+『名』》;(…を)こっそりのぞく《+『at』(『into』)+『名』》 / 〈草花・太陽などが〉出始める,顔を出す / 《しばしばa~》『のぞき見』,かいま見ること / 《the~》(太陽などの)出配め,出現《+『of』+『名』》
(ひな鳥・ネズミなどの鳴き声の)ピーピー,チューチュー / 《単数形で》《話》不平,泣き言 / ピーピー(チューチュー)鳴く
《米話》=automobile

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/12/09 17:18:24」(JST)

wiki en

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.^[1] The two types of PEEP are extrinsic PEEP (PEEP applied by a ventilator) and intrinsic PEEP (PEEP caused by a non-complete exhalation). Pressure that is applied or increased during an inspiration is termed pressure support.

Intrinsic PEEP (auto)[edit]

Auto (intrinsic) PEEP — Incomplete expiration prior to the initiation of the next breath causes progressive air trapping (hyperinflation). This accumulation of air increases alveolar pressure at the end of expiration, which is referred to as auto-PEEP.

Auto-PEEP develops commonly in high minute ventilation (hyperventilation), expiratory flow limitation (obstructed airway) and expiratory resistance (narrow airway).

Once auto-PEEP is identified, steps should be taken to stop or reduce the pressure build-up.^[2] When auto-PEEP persists despite management of its underlying cause, applied PEEP may be helpful if the patient has an expiratory flow limitation (obstruction).^[3]^[4]

Extrinsic PEEP (applied)[edit]

Applied (extrinsic) PEEP — is usually one of the first ventilator settings chosen when mechanical ventilation is initiated. It is set directly on the ventilator.

A small amount of applied PEEP (3 to 5 cmH₂O) is used in most mechanically ventilated patients to mitigate end-expiratory alveolar collapse.^[5] A higher level of applied PEEP (>5 cmH₂O) is sometimes used to improve hypoxemia or reduce ventilator-associated lung injury in patients with acute lung injury, acute respiratory distress syndrome, or other types of hypoxemic respiratory failure.^[6]

Complications[edit]

Positive end-expiratory pressure can contribute to:

Decrease in systemic venous return
Pulmonary barotrauma can be caused. Pulmonary barotrauma is lung injury that results from the hyperinflation of alveoli past the rupture point.
Increased intracranial pressure — In people with normal lung compliance, PEEP may increase the intracranial pressure (ICP) due to an impedance of venous return from the head.^[7]
Renal functions and electrolyte imbalances, due to decreased venous return metabolism of certain drugs are altered and acid-base balance is impeded.^[8]

References[edit]

^ thefreedictionary.com > positive end-expiratory pressure (PEEP) Citing: Saunders Comprehensive Veterinary Dictionary, 2007
^ Caramez MP; Borges JB; Tucci MR; Okamoto VN; Carvalho CR; Kacmarek RM; Malhotra, A; Velasco, IT et al. (2005). "Paradoxical responses to positive end-expiratory pressure in patients with airway obstruction during controlled ventilation". Crit Care Med 33 (7): 1519–28. doi:10.1097/01.CCM.0000168044.98844.30. PMC 2287196. PMID 16003057. |displayauthors= suggested (help)
^ Smith TC, Marini JJ (1988). "Impact of PEEP on lung mechanics and work of breathing in severe airflow obstruction". J Appl Physiol 65 (4): 1488–99. PMID 3053583.
^ Kondili E, Alexopoulou C, Prinianakis G, Xirouchaki N, Georgopoulos D (2004). "Pattern of lung emptying and expiratory resistance in mechanically ventilated patients with chronic obstructive pulmonary disease". Intensive Care Med 30 (7): 1311–8. doi:10.1007/s00134-004-2255-z. PMID 15054570.
^ Manzano F, Fernández-Mondéjar E, Colmenero M, Poyatos ME, Rivera R, Machado J et al. (2008). "Positive-end expiratory pressure reduces incidence of ventilator-associated pneumonia in nonhypoxemic patients". Crit Care Med 36 (8): 2225–31. doi:10.1097/CCM.0b013e31817b8a92. PMID 18664777.
^ Smith, RA. Physiologic PEEP. Respir Care 1988; 33:620.
^ Frost EA (1977). "Effects of positive end-expiratory pressure on intracranial pressure and compliance in brain-injured patients". J Neurosurg 47 (2): 195–200. doi:10.3171/jns.1977.47.2.0195. PMID 327031.
^ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC471250/

External links[edit]

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 呼気終末陽圧（PEEP） positive end expiratory pressure peep
2. 機械的人工換気の生理学的および病理生理学的転帰 physiologic and pathophysiologic consequences of mechanical ventilation
3. COPDを合併した急性呼吸不全における機械的人工換気 mechanical ventilation in acute respiratory failure complicating copd
4. 成人の喘息急性増悪時の侵襲的機械的人工換気 invasive mechanical ventilation in adults with acute exacerbations of asthma
5. 人工呼吸患者における呼吸窮迫の評価 assessment of respiratory distress in the mechanically ventilated patient

English Journal

Hemodynamic Consequences of Auto-PEEP.

Berlin D.AbstractAuto-positive end-expiratory pressure (PEEP) is a common but frequently unrecognized problem in critically ill patients. It has important physiologic consequences and can cause shock and cardiac arrest. Treatment consists of relieving expiratory airflow obstruction and reducing minute ventilation delivered by positive pressure ventilation. Sedation and fluid management are important adjunctive therapies. This analytic review discusses the prevalence, pathophysiology, and hemodynamic consequences of auto-PEEP and an approach to its treatment.
Journal of intensive care medicine.J Intensive Care Med.2012 May 15. [Epub ahead of print]
Auto-positive end-expiratory pressure (PEEP) is a common but frequently unrecognized problem in critically ill patients. It has important physiologic consequences and can cause shock and cardiac arrest. Treatment consists of relieving expiratory airflow obstruction and reducing minute ventilation de
PMID 22588373

Effects of duty cycle and positive end-expiratory pressure on mucus clearance during mechanical ventilation*.

Li Bassi G, Saucedo L, Marti JD, Rigol M, Esperatti M, Luque N, Ferrer M, Gabarrus A, Fernandez L, Kolobow T, Torres A.SourceHospital Clínic, Thorax Institute, Pneumology Department, Barcelona, Spain.
Critical care medicine.Crit Care Med.2012 Mar;40(3):895-902.
OBJECTIVES: During mechanical ventilation, air flows may play a role in mucus transport via two-phase gas liquid flow. The aim of this study was to evaluate effects of duty cycles and positive end-expiratory pressure on mucus clearance in pigs using mechanical ventilation, and to assess their safety
PMID 22080638

Japanese Journal

PEEPとCPAP (特集呼吸管理プラクティカルガイド) -- (急性呼吸不全に対する換気様式の概念と適応)

鳥海岳
救急医学 34(10), 1268-1272, 2010-09
NAID 40017320799

Auto-PEEP (特集急性呼吸不全に対する呼吸管理ベストプラクティス) -- (急性呼吸不全患者のモニタリング)

中根正樹
救急医学 28(10), 1182-1187, 2004-09
NAID 40006430027

Related Pictures

★リンクテーブル★

リンク元	「自動呼気終末陽圧」「オートピープ」「intrinsic positive-pressure respiration」
関連記事	「PE」「aut」「PEEP」「auto」