Finding the Auto PEEP

The consequences of excessive auto PEEP can be fatal, so it’s important that we are checking for it regularly on patients that have a high risk of air trapping.  Fortunately, it’s not very difficult to do!  There are 3 ways you can look for evidence of auto PEEP on the ventilator:

1. Do an end-expiratory hold If the measured PEEP is more than the PEEP set on the vent after a 2-3 second hold, the difference is your auto PEEP

Finding the AutoPEEP
from on Vimeo.


2. Look at the inspiratory/expiratory flow waveform:  If the waveform does not return to baseline (still expiring when delivery of breath initiates), there’s probably auto PEEP!


3. Compare the inspiratory vs. expiratory volumes.  If the inspiratory volumes are much higher then the expiratory volumes, consider auto PEEP.

Checking for auto PEEP is a simple, but critical assessment that should be made regularly on patients requiring mechanical ventilation.

Thanks to Dr. Michael Scott (@HandsomeMikeMD) and Dr. Nirav Shah (@ngshah1) for submitting the videos above!!

About the Author

John Greenwood

Creator of the PressorDex & . Resuscitationist, Heart & Vascular ICU Intensivist. Focus in mechanical circulatory support & medical education #FOAMcc #FOAMed Twitter: @johngreenwoodmd Email:

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