Peep should be high or low in pulmonary edema
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pulmonary edema noninvasive ventilation PEEP guideline cardiogenic pulmonary edema
PEEP is generally increased to a moderate level in pulmonary edema, not kept very low.
- It recruits fluid-filled/collapsed alveoli and improves oxygenation.
- In cardiogenic pulmonary edema, CPAP or PEEP also reduces venous return and left-ventricular afterload, helping reduce pulmonary congestion.
- A common starting range is 5-10 cm H₂O, then titrate to oxygenation, respiratory effort, blood pressure, and lung mechanics.
Avoid excessively high PEEP, particularly if the patient is hypotensive, in cardiogenic shock, or has right-ventricular failure, because it can decrease venous return and cardiac output.
So: moderate PEEP, titrated carefully, rather than “as high as possible.” Fishman notes that PEEP can improve pulmonary edema by shifting alveolar edema fluid and increasing end-expiratory lung volume. Fishman's Pulmonary Diseases and Disorders, positive end-expiratory pressure section.
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