Auto-PEEP is air trapping caused when a person fails to exhale entirely before initiation of the next breath
Auto-PEEP is air trapping caused when a person fails to exhale entirely before initiation of the next breath. Asthmatic patients are predisposed to developing Auto-PEEP because the obstructive nature of asthma causes a reduction in expiratory time, which is observed in the patient’s increased respiratory rate. Therefore a patient diagnosed with asthma is likely to develop PEEP because the patient’s inspiratory time and tidal volume are also disrupted.
The ventilator settings were appropriate. The patient should initially be on assist control mode, and the pressure in the ventilator should be set to achieve a small tidal volume of 5-7ml/kg depending on the patient weight, and for most adults, 500mls is ideal. The respiratory rate set was alright for the given patient because it is slow as desired set at 12. Minimal PEEP should be used, and the patient is placed on a PEEP of 5, which was appropriate. The FiO2 supply to the patient is 100%, which is okay initially, but it should be titrated downwards so that it ranges between 90-92%. The initial 100% FiO2 is appropriate to allow the patient to achieve arterial oxygenation. Still, it should be titrated so that it does not interfere with the patient’s ventilation and perfusion match, worsening hypercapnia condition.
After the first check-up, the patient had increased peak inspiratory pressure and plateau pressure and developed Auto-PEEP even though the initial ventilator setting is appropriate. Therefore, it suggests that there is a need to reduce the set respiratory rate to about 10 to prevent the development of auto-PEEP, and the used PEEP of five should be reduced further.