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Positive-Pressure Respiration, Intrinsic

MedGen UID:
69231
•Concept ID:
C0242676
•
Disease or Syndrome
Synonyms: Auto PEEP; Auto-PEEP; AutoPEEP; Intrinsic PEEP; Intrinsic Positive-Pressure Respiration; Non Therapeutic Positive Pressure Respiration; Non-Therapeutic Positive-Pressure Respiration; Nontherapeutic Positive Pressure Respiration; Nontherapeutic Positive-Pressure Respiration; Occult PEEP; Occult Positive-Pressure Respiration; PEEP, Intrinsic; PEEP, Occult; Positive Pressure Respiration, Intrinsic; Positive Pressure Respiration, Non Therapeutic; Positive Pressure Respiration, Nontherapeutic; Positive Pressure Respiration, Occult; Positive-Pressure Respiration, Non-Therapeutic; Positive-Pressure Respiration, Nontherapeutic; Positive-Pressure Respiration, Occult; Respiration, Intrinsic Positive-Pressure; Respiration, Non Therapeutic Positive Pressure; Respiration, Non-Therapeutic Positive-Pressure; Respiration, Nontherapeutic Positive Pressure; Respiration, Nontherapeutic Positive-Pressure; Respiration, Occult Positive-Pressure

Definition

Non-therapeutic positive end-expiratory pressure occurring frequently in patients with severe airway obstruction. It can appear with or without the administration of external positive end-expiratory pressure (POSITIVE-PRESSURE RESPIRATION). It presents an important load on the inspiratory muscles which are operating at a mechanical disadvantage due to hyperinflation. Auto-PEEP may cause profound hypotension that should be treated by intravascular volume expansion, increasing the time for expiration, and/or changing from assist mode to intermittent mandatory ventilation mode. (From Harrison''s Principles of Internal Medicine, 12th ed, p1127) [from MeSH]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVPositive-Pressure Respiration, Intrinsic

Professional guidelines

PubMed

Management of mechanical ventilation in acute severe asthma: practical aspects.
Oddo M, Feihl F, Schaller MD, Perret C
Intensive Care Med 2006 Apr;32(4):501-10. Epub 2006 Jan 27 doi: 10.1007/s00134-005-0045-x. PMID: 16552615
Auto-positive end-expiratory pressure: mechanisms and treatment.
Mughal MM, Culver DA, Minai OA, Arroliga AC
Cleve Clin J Med 2005 Sep;72(9):801-9. doi: 10.3949/ccjm.72.9.801. PMID: 16193827
Dynamic pulmonary hyperinflation and intrinsic PEEP: consequences and management in patients with chronic obstructive pulmonary disease.
Milic-Emili J
Recenti Prog Med 1990 Nov;81(11):733-7. PMID: 2126881

Recent clinical studies

Etiology

Intrinsic Dynamic Positive End-Expiratory Pressure in Stable Patients with Chronic Obstructive Pulmonary Disease.
Vitacca M, Ceriana P, Prediletto I, Carlucci A, Paneroni M, Ambrosino N, Nava S
Respiration 2020;99(12):1129-1135. Epub 2020 Dec 3 doi: 10.1159/000511266. PMID: 33271563
Transpulmonary Pressure Describes Lung Morphology During Decremental Positive End-Expiratory Pressure Trials in Obesity.
Fumagalli J, Berra L, Zhang C, Pirrone M, Santiago RRS, Gomes S, Magni F, Dos Santos GAB, Bennett D, Torsani V, Fisher D, Morais C, Amato MBP, Kacmarek RM
Crit Care Med 2017 Aug;45(8):1374-1381. doi: 10.1097/CCM.0000000000002460. PMID: 28708679
Intrinsic positive end-expiratory pressure during ventilation through small endotracheal tubes during general anesthesia: incidence, mechanism, and predictive factors.
Gemma M, Nicelli E, Corti D, De Vitis A, Patroniti N, Foti G, Calvi MR, Beretta L
J Clin Anesth 2016 Jun;31:124-30. Epub 2016 Apr 16 doi: 10.1016/j.jclinane.2016.01.029. PMID: 27185694
Intrinsic positive end-expiratory pressure in mechanically ventilated patients with and without tidal expiratory flow limitation.
Armaganidis A, Stavrakaki-Kallergi K, Koutsoukou A, Lymberis A, Milic-Emili J, Roussos C
Crit Care Med 2000 Dec;28(12):3837-42. doi: 10.1097/00003246-200012000-00015. PMID: 11153623
Ventilatory care in status asthmaticus.
Smyth RJ
Can Respir J 1998 Nov-Dec;5(6):485-90. doi: 10.1155/1998/356467. PMID: 10070176

Diagnosis

Abordaje hemodinámico y ventilatorio en pacientes con COVID-19.
Carrillo-Esper R, Mejía-Gómez L, Monares-Zepeda E, Chavarría-Martínez U, Díaz-Carrillo A, Ayala-León M, Zamora-Gómez S, Sánchez-Díaz JS, Lomelí-Terán M, Briones-Garduño JC, Pérez-Calatayud ÁA
Cir Cir 2020;88(6):805-817. doi: 10.24875/CIRU.20000301. PMID: 33254199
Expiratory Flow Limitation During Mechanical Ventilation.
Junhasavasdikul D, Telias I, Grieco DL, Chen L, Gutierrez CM, Piraino T, Brochard L
Chest 2018 Oct;154(4):948-962. Epub 2018 Feb 9 doi: 10.1016/j.chest.2018.01.046. PMID: 29432712
Positive end expiratory pressure titration guided by plateau pressure in chronic obstructive pulmonary disease patients.
Liang G, Zhang Z
Clin Respir J 2018 Feb;12(2):674-680. Epub 2016 Nov 10 doi: 10.1111/crj.12578. PMID: 27805309
Auto-PEEP in respiratory failure.
Laghi F, Goyal A
Minerva Anestesiol 2012 Feb;78(2):201-21. Epub 2011 Nov 18 PMID: 21971439
Measurement of air trapping, intrinsic positive end-expiratory pressure, and dynamic hyperinflation in mechanically ventilated patients.
Blanch L, Bernabé F, Lucangelo U
Respir Care 2005 Jan;50(1):110-23; discussion 123-4. PMID: 15636649

Therapy

Expiratory Flow Limitation During Mechanical Ventilation.
Junhasavasdikul D, Telias I, Grieco DL, Chen L, Gutierrez CM, Piraino T, Brochard L
Chest 2018 Oct;154(4):948-962. Epub 2018 Feb 9 doi: 10.1016/j.chest.2018.01.046. PMID: 29432712
Transpulmonary Pressure Describes Lung Morphology During Decremental Positive End-Expiratory Pressure Trials in Obesity.
Fumagalli J, Berra L, Zhang C, Pirrone M, Santiago RRS, Gomes S, Magni F, Dos Santos GAB, Bennett D, Torsani V, Fisher D, Morais C, Amato MBP, Kacmarek RM
Crit Care Med 2017 Aug;45(8):1374-1381. doi: 10.1097/CCM.0000000000002460. PMID: 28708679
Hemodynamic consequences of auto-PEEP.
Berlin D
J Intensive Care Med 2014 Mar-Apr;29(2):81-6. Epub 2012 May 15 doi: 10.1177/0885066612445712. PMID: 22588373
Measurement of air trapping, intrinsic positive end-expiratory pressure, and dynamic hyperinflation in mechanically ventilated patients.
Blanch L, Bernabé F, Lucangelo U
Respir Care 2005 Jan;50(1):110-23; discussion 123-4. PMID: 15636649
Ventilatory care in status asthmaticus.
Smyth RJ
Can Respir J 1998 Nov-Dec;5(6):485-90. doi: 10.1155/1998/356467. PMID: 10070176

Prognosis

Mean Airway Pressure As a Predictor of 90-Day Mortality in Mechanically Ventilated Patients.
Sahetya SK, Wu TD, Morgan B, Herrera P, Roldan R, Paz E, Jaymez AA, Chirinos E, Portugal J, Quispe R, Brower RG, Checkley W, Capanni F, Caravedo MA, Cerna J, Davalos L, De Ferrari A, Denney JA, Dulanto A, Mongilardi N, Paredes C, Pereda MA, Shams N; INTENSIVOS Cohort Study; INTENSIVOS Cohort Study are as follows
Crit Care Med 2020 May;48(5):688-695. doi: 10.1097/CCM.0000000000004268. PMID: 32079893Free PMC Article
Positive end expiratory pressure titration guided by plateau pressure in chronic obstructive pulmonary disease patients.
Liang G, Zhang Z
Clin Respir J 2018 Feb;12(2):674-680. Epub 2016 Nov 10 doi: 10.1111/crj.12578. PMID: 27805309
Transpulmonary Pressure Describes Lung Morphology During Decremental Positive End-Expiratory Pressure Trials in Obesity.
Fumagalli J, Berra L, Zhang C, Pirrone M, Santiago RRS, Gomes S, Magni F, Dos Santos GAB, Bennett D, Torsani V, Fisher D, Morais C, Amato MBP, Kacmarek RM
Crit Care Med 2017 Aug;45(8):1374-1381. doi: 10.1097/CCM.0000000000002460. PMID: 28708679
Intrinsic positive end-expiratory pressure during ventilation through small endotracheal tubes during general anesthesia: incidence, mechanism, and predictive factors.
Gemma M, Nicelli E, Corti D, De Vitis A, Patroniti N, Foti G, Calvi MR, Beretta L
J Clin Anesth 2016 Jun;31:124-30. Epub 2016 Apr 16 doi: 10.1016/j.jclinane.2016.01.029. PMID: 27185694
Measurement of pressure-volume curves in patients on mechanical ventilation: methods and significance.
Lu Q, Rouby JJ
Crit Care 2000;4(2):91-100. Epub 2000 Mar 21 doi: 10.1186/cc662. PMID: 11094498Free PMC Article

Clinical prediction guides

Intrinsic Dynamic Positive End-Expiratory Pressure in Stable Patients with Chronic Obstructive Pulmonary Disease.
Vitacca M, Ceriana P, Prediletto I, Carlucci A, Paneroni M, Ambrosino N, Nava S
Respiration 2020;99(12):1129-1135. Epub 2020 Dec 3 doi: 10.1159/000511266. PMID: 33271563
Mean Airway Pressure As a Predictor of 90-Day Mortality in Mechanically Ventilated Patients.
Sahetya SK, Wu TD, Morgan B, Herrera P, Roldan R, Paz E, Jaymez AA, Chirinos E, Portugal J, Quispe R, Brower RG, Checkley W, Capanni F, Caravedo MA, Cerna J, Davalos L, De Ferrari A, Denney JA, Dulanto A, Mongilardi N, Paredes C, Pereda MA, Shams N; INTENSIVOS Cohort Study; INTENSIVOS Cohort Study are as follows
Crit Care Med 2020 May;48(5):688-695. doi: 10.1097/CCM.0000000000004268. PMID: 32079893Free PMC Article
Transpulmonary Pressure Describes Lung Morphology During Decremental Positive End-Expiratory Pressure Trials in Obesity.
Fumagalli J, Berra L, Zhang C, Pirrone M, Santiago RRS, Gomes S, Magni F, Dos Santos GAB, Bennett D, Torsani V, Fisher D, Morais C, Amato MBP, Kacmarek RM
Crit Care Med 2017 Aug;45(8):1374-1381. doi: 10.1097/CCM.0000000000002460. PMID: 28708679
Measurement of air trapping, intrinsic positive end-expiratory pressure, and dynamic hyperinflation in mechanically ventilated patients.
Blanch L, Bernabé F, Lucangelo U
Respir Care 2005 Jan;50(1):110-23; discussion 123-4. PMID: 15636649
Intrinsic PEEP and cardiopulmonary interaction in patients with COPD and acute ventilatory failure.
Ranieri VM, Dambrosio M, Brienza N
Eur Respir J 1996 Jun;9(6):1283-92. doi: 10.1183/09031936.96.09061283. PMID: 8804950

Recent systematic reviews

Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation.
Hodgson C, Goligher EC, Young ME, Keating JL, Holland AE, Romero L, Bradley SJ, Tuxen D
Cochrane Database Syst Rev 2016 Nov 17;11(11):CD006667. doi: 10.1002/14651858.CD006667.pub3. PMID: 27855477Free PMC Article
Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis.
Aldenkortt M, Lysakowski C, Elia N, Brochard L, Tramèr MR
Br J Anaesth 2012 Oct;109(4):493-502. doi: 10.1093/bja/aes338. PMID: 22976857

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