Role of continuous positive airway pressure in the intensive care unit

N. Ambrosino, M. Vitacca

Research output: Contribution to journalArticlepeer-review

Abstract

Continuous positive airway pressure (CPAP) is the application of a constant level of positive pressure at the airway opening during spontaneous ventilation either through a mask or an endotracheal tube. Positive end- expiratory pressure (PEEP) refers to maintaining airway pressure above atmospheric at end-expiration during mechanical ventilation. Use of CPAP or PEEP is a key therapy in the management of acute respiratory failure (ARF). Most of the effects of CPAP on the cardiorespiratory system are similar to the effects of PEEP. While the early aggressive use of PEEP in adult respiratory distress syndrome is still discussed, the use of PEEP is now also being extended to chronic obstructive pulmonary disease (COPD) patients with dynamic pulmonary hyperinflation. In patients with acute lung injury and severe hypoxaemia, PEEP improves arterial oxygen tension probably through one or more mechanisms: increase in end-expiratory lung volume, recruitment of unventilated alveoli, decreased perfusion of unventilated alveoli, improvement in the ventilation/perfusion mismatching and decreased intrapulmonary shunt. PEEP can also prevent additional lung injury resulting from excessive volume excursion during mechanical ventilation. In patients with an acute exacerbation of COPD, PEEP can reduce the inspiratory muscle effort counterbalancing the inspiratory threshold resulting from intrinsic PEEP (PEEPi). For this purpose, a level of PEEP

Original languageEnglish
Pages (from-to)194-223
Number of pages30
JournalEuropean Respiratory Monograph
Volume3
Issue number8
Publication statusPublished - 1998

Keywords

  • Acute lung injury
  • Acute respiratory failure
  • Chronic obstructive pulmonary disease
  • End-expiratory pressure
  • Hypoxaemia
  • Mechanical ventilation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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