Respiratory Therapy - Finding The Optimal PEEP

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[00:00:00]What we see is is we have a patient who we're we're we're doing a peep titration study on. So, we're monitoring peep levels for this. We're trying to find best or optimal peep, okay? And so, what we see here is that the patient we increased it to eight and then we increased it to 10, we increased it to 12, we increased it to 14. Now, on the side over here, we see the variables that we talked about in the previous slide where we talked about FRC. PAO2, we talked about static compliance, and we talked about cardiac output. Now, watching this chart, and if you want to, pause this video, take a look at it and just say, "Okay, where is optimal peep?"

[00:00:39]Where where is it at? And if you think about what I said previously, it should make sense to you, right? Because remember, there's lots of variables.

[00:00:48]Neither one is is trumps the other. They have to all work in accord, okay? So, we see here is is that when we went to eight, there was an increase in our FRC, which increased our PAO2, and our static compliance got better. Our cardiac output was not affected. We went to 10.

[00:01:06]Same thing. FRC improved, PAO2 improved, static compliance improved.

[00:01:12]Hemodynamically, cardiac output not affected. We go one more to peep of 12 and we see FRC got larger. Look, anytime you increase peep, you're going to increase FRC. The question is, when does that get dangerous, okay? FRC goes up, PAO2 goes up, static compliance improves again.

[00:01:32]Cardiac output remains unaffected. Watch this.

[00:01:36]FRC increases when we go to peep of 14.

[00:01:39]PAO2 therefore increases when we go into a peep of 14. But this time when we went to a peep of 14, our static compliance decreased. That right there.

[00:01:50]Also, we see our cardiac output decreased. What does that tell us? That tells us that at this point right here at this point right here this changed, which tells us that the PEEP change from 12 to 14 exceeded best or optimal PEEP. So, where is optimal PEEP for this patient? If this happens at 14, we go back and that would be our optimal PEEP level.