title: Auto-positive end-expiratory pressure and dynamic hyperinflation.
abstract: PEEP is indicated in patients with COPD only to unload the respiratory muscles from the auto-PEEP resulting from expiratory flow limitation. If auto-PEEP is not caused by flow limitation, application of PEEP will cause further hyperinflation, worsening respiratory mechanics, muscle activity, and hemodynamics. To assess the presence of expiratory flow limitation correctly, to measure auto-PEEP correctly, and to identify the maximal PEEP level to be used, measurements of flow and opening pressure must be obtained during a brief period of suspended respiratory muscle activity (obtained by sedation) with the patient's own breathing pattern reproduced accurately.
authors.affiliation: Istituto di Anestesiologia e Rianimazione, Ospedale Policlinico, Università di Bari, Italy.
authors.forename: V M
authors.initials: VM
authors.lastname: Ranieri
authors.forename: S
authors.initials: S
authors.lastname: Grasso
authors.forename: T
authors.initials: T
authors.lastname: Fiore
authors.forename: R
authors.initials: R
authors.lastname: Giuliani
mesh_terms: D006801:Humans; D008173:Lung Diseases, Obstructive / Q000503:physiopathology* / Q000628:therapy*; D011175:Positive-Pressure Respiration; D018467:Positive-Pressure Respiration, Intrinsic / Q000503:physiopathology* / Q000628:therapy*; D012129:Respiratory Function Tests; D012132:Respiratory Muscles / Q000503:physiopathology