“INADVERTENT PEEP” WITH THE USE OF A CONVENTIONAL VENTILATOR IS UNDETECTED BY PROXIMAL AIRWAY PRESSURE MONITOR

Abstract

"Inadvertent PEEP" develops during high frequency ventilation. This effect is not as well recognized using a conventional ventilator at high frequencies. A neonatal lung model with respiratory compliance of 3.3 ml/cm H₂O and a pressure tap to measure alveolar pressure (Palv) was ventilated with a Baby Bird through a 2.5 mm ID neonatal ET tube at 20 to 100 breaths per minute (BPM) using a variety of I:E ratios, peak pressures, and end expiratory pressures. Proximal airway pressure (Paw) was measured at the ET tube adaptor. End tidal Palv increased as frequency, peak pressure and I:E ratios were increased even if the ventilator was set at zero PEEP. This inadvertent increase in Palv was not detected by the proximal airway pressure monitor even though the "Inadvertent PEEP" (Palv-Paw) was as great as 9.8 cmH₂O at 100 BPM. "inadvertent PEEP" is the result of insufficient expiratory time at high ventilator rates, and its magnitude is decreased by increasing expiratory time.

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