What is the role of positive-end expiratory pressure (PEEP) in pulmonary artery catheterization (PAC)?

Updated: Dec 22, 2017
  • Author: Bojan Paunovic, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

PEEP (intrinsic or extrinsic) also transmits pressure to the vascular space. Lung compliance is the main determinant of the amount of pressure transmission. For example, in disease states (eg, ARDS) associated with low compliance (ie, stiff lungs), pressure transmission is minimal. Debate exists over how to correct PCWP in the presence of PEEP. Although previously advocated, temporary discontinuation of PEEP may have adverse effects, such as cardiovascular collapse or hypoxemia, that are difficult to reverse.

For PEEP greater than 10 cm H2 O, the following general rule can be applied: Corrected PCWP equals measured PCWP minus one half the quotient of PEEP divided by 1.36. If available, an intraesophageal balloon can be used. Esophageal pressure equals pleural pressure, so corrected PCWP equals measured PCWP minus esophageal pressure.


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