Prolonged Continuous Positive Pressure

  • Period of continuous high pressure via the ventilator
  • Example: 40cm H20 for 40 seconds often used

Staircase Manoeuvre

  • Stepped increase in PEEP with the maintenance of normal driving pressure:
  • Example: PEEP is increased in increments of 2–5 cm H2O to a maximum of 30cm H20 with a fixed VT of 6 mL/kg. Each step is held for 2-3 minutes unless adverse effects (hypotension, desaturation)

Use of ‘Sighs’

  • Sighs describe the use of periodic deep breaths of 1.5-2x normal tidal volume delivered regularly by the ventilator
  • Example: Sighs at a rate of 1-2 sighs/min pressures can be used to establish transpulmonary pressures and optimise PEEP