Method
Steps
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