Positive-end expiratory pressure reduces incidence of ventilator-associated pneumonia in nonhypoxemic patients*

Abstract

These findings indicate that application of prophylactic PEEP in nonhypoxemic ventilated patients reduces the number of hypoxemia episodes and the incidence of ventilator-associated pneumonia.

Positive airway pressure therapy for heart failure

“…First, PAP maintains alveolar pressure and prevents the alveoli from collapsing at the end of expiration and thus improves gas exchange and oxygenation through the recruitment of alveolar units, counterbalance of hydrostatic forces leading to pulmonary edema, and maintenance of airway patency [19][20][21][22] . Particularly in HF patients with pulmonary congestion in whom lung compliance is impaired, PAP induces recruitment of collapsed alveoli, reversal of atelectasis, and induces a fluid shift from the alveoli and the interstitial space to the pulmonary circulation, consequently decreasing the amount of intrapulmonary shunting and improving oxygenation [21,23] .…”

Novel Endotracheal Tube Cuffs: Improving the Seal as a Barrier to Leakage

“…[8][9][10]13 However, the study's measurement conditions did not include PEEP or mechanical ventilation, so the benefit of the new cuff in the presence of positive-pressure ventilation is unknown, given that PEEP influences the rate of fluid leak. 9,[12][13][14]16 The selection of a round, inflexible acrylic tube for a trachea model, although common in the literature, 3,8,11 may not translate in vivo, because the most common tracheal cross-sectional shape is an ellipse. 6 Young et al reported that, with an acrylic tube as the trachea model, all the endotracheal tube cuffs tested demonstrated leak, but only 45% of the tubes had a leak when examined in a porcine trachea.…”

“…2,[7][8][9][10][11] The flow of secretions past the cuff is determined by the height of the column above the cuff, the angle of inclination, the cuff inflation pressure, and the tracheal pressure applied by the ventilator. 9,[12][13][14] The addition of PEEP has been shown, both in vivo and in vitro, to counterbalance this hydraulic force and to limit the leakage past the cuff. 9,13,14 The endotracheal tube and cuff were recently examined for their contributions to VAP.…”

“…9,[12][13][14] The addition of PEEP has been shown, both in vivo and in vitro, to counterbalance this hydraulic force and to limit the leakage past the cuff. 9,13,14 The endotracheal tube and cuff were recently examined for their contributions to VAP. Several studies looked at cuff design and how it affects microaspiration under various conditions.…”

Adaptive Servo-Ventilation Treatment Increases Stroke Volume in Stable Systolic Heart Failure Patients With Low Tricuspid Annular Plane Systolic Excursion

“…4) Positive end-expiratory pressure (PEEP) ameliorates the hemodynamic state in HF patients through the following mechanisms; reduction of left ventricular (LV) afterload, 5) reduction of LV preload, 6) decrease in work of breathing, and reversal of hypoxia-related pulmonary vasoconstriction. 7) However, the mechanisms by which PEEP improves the respiratory status in HF patients have not been fully elucidated.…”