How I Teach Auto-PEEP: Applying the Physiology of Expiration

Abstract

Teaching complex topics in mechanical ventilation can prove challenging for clinical educators, both at the bedside and in the classroom setting. Some of these topics, such as the topic of auto-positive end-expiratory pressure (auto-PEEP), consist of complicated physiological principles that can be difficult to convey in an organized and intuitive manner. In this entry of “How I Teach,” we provide an approach to teaching the concept of auto-PEEP to senior residents and fellows working in the intensive care unit. We offer a framework for educators to effectively present the concepts of auto-PEEP to learners, either at the bedside or in the classroom setting, by summarizing key concepts and including concrete examples of the educational techniques we use. This framework includes specific content we emphasize, how to present this content using a variety of educational resources, assessing learner understanding, and how to modify the topic on the basis of location, time, or resource constraints.

Adjusting ventilator settings to avoid air trapping in extremely premature infants reduces the need for tracheostomy and length of stay

“…Patient/ventilator asynchrony, demonstrated by patient efforts that do not result in a ventilator delivered breath despite appropriate trigger sensitivity, can be a sign of autoPEEP (31). When present, incremental increases in the PEEP to a level higher than the autoPEEP will improve patient/ventilator synchronicity and often decreases patient agitation.…”

“…If missed triggers are noted, and trigger sensitivity is appropriately set, it is likely that autoPEEP is interfering with the sensor's ability to detect the patient's attempts to breathe. To minimize autoPEEP, the PEEP is increased until patient ventilator synchronicity is reestablished (31,32). Pressure-Volume loops and Flow-Volume loops are then assessed for improvement in obstructive patterns.…”

“How I Teach”: A Novel Guide to Teaching in Pulmonary, Critical Care, and Sleep Medicine

“…These two outstanding pieces reflect our initial vision when we proposed this new category of teaching review and serve as models for future manuscripts in this new submission category. The first focuses on how to teach about the concept of auto-positive end-expiratory pressure (auto-PEEP) ( 2 ) and the second on the use of ultrasound to place a peripheral intravenous catheter ( 3 ). These two papers demonstrate the spectrum of topics that are particularly appropriate, with one describing a simple way to teach a highly complex concept and the other sharing an expert approach to an everyday procedure in the hospital.…”