Airway Occlusion Pressure to Titrate Positive End-expiratory Pressure in Patients with Dynamic Hyperinflation

Patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) who require intubation and mechanical ventilation frequently exhibit dynamic hyperinflation responsible for an auto or intrinsic positive end-expiratory pressure (PEEPi). ‘” The presence of PEEPi implies that alveolar pressure at end expiration is higher than airway opening pressure. This phenomenon may occur because the expiratory time is too short to allow complete lung emptying in the case of abnormalities in lung compliance and lung and airway resistances (including those of the endotracheal tube and the expiratory circuit of the ventilator) and in the presence of a high minute ventilation. More importantly, expiratory dynamic flow limitation is a frequent cause of air trapping and dynamic hyperinflation with PEEPi.

Airway Occlusion Pressure to Titrate Positive End-expiratory Pressure in Patients with Dynamic Hyperinflation
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