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Intrinsic Positive-Pressure Respiration

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Non-therapeutic positive end-expiratory pressure occurring frequently in patients with severe airway obstruction. It can appear with or without the administration of external positive end-expiratory pressure (POSITIVE-PRESSURE RESPIRATION). It presents an important load on the inspiratory muscles which are operating at a mechanical disadvantage due to hyperinflation. Auto-PEEP may cause profound hypotension that should be treated by intravascular volume expansion, increasing the time for expiration, and/or changing from assist mode to intermittent mandatory ventilation mode. (From Harrison's Principles of Internal Medicine, 12th ed, p1127)

Also Known As:

Positive-Pressure Respiration, Intrinsic; AutoPEEP; Non-Therapeutic Positive-Pressure Respiration; Nontherapeutic Positive-Pressure Respiration; Positive-Pressure Respiration, Non-Therapeutic; Positive-Pressure Respiration, Nontherapeutic; Respiration, Non-Therapeutic Positive-Pressure; Respiration, Nontherapeutic Positive-Pressure; Auto PEEP; Intrinsic PEEP; Non Therapeutic Positive Pressure Respiration; Nontherapeutic Positive Pressure Respiration; Occult PEEP; Occult Positive-Pressure Respiration; Positive Pressure Respiration, Intrinsic; Positive Pressure Respiration, Non Therapeutic; Positive Pressure Respiration, Nontherapeutic; Positive Pressure Respiration, Occult; Respiration, Intrinsic Positive-Pressure; Respiration, Non Therapeutic Positive Pressure; Respiration, Nontherapeutic Positive Pressure; Respiration, Occult Positive-Pressure; Auto-PEEP; PEEP, Intrinsic; PEEP, Occult; Positive-Pressure Respiration, Occult

Networked: 142 relevant articles (7 outcomes, 10 trials/studies)

Relationship Network

Disease Context: Research Results

Respiratory Tract Diseases: 445
- Respiration Disorders: 12
  - Respiratory Insufficiency: 13810
    - Intrinsic Positive-Pressure Respiration: 142

Related Diseases

1.	Intrinsic Positive-Pressure Respiration
2.	Chronic Obstructive Pulmonary Disease (COPD)
3.	Tracheobronchomalacia
4.	Vocal Cord Paralysis
5.	Critical Illness (Critically Ill)

Experts

1.	Kacmarek, Robert M: 2 articles (11/2014 - 07/2005)
2.	Patroniti, Nicolò: 2 articles (09/2014 - 06/2002)
3.	Pesenti, Antonio: 2 articles (09/2014 - 06/2002)
4.	Harf, A: 2 articles (01/2013 - 07/2000)
5.	Mancebo, J: 2 articles (01/2013 - 07/2000)
6.	Brochard, L: 2 articles (01/2013 - 07/2000)
7.	Brochard, Laurent: 2 articles (11/2008 - 10/2002)
8.	Loop, T: 1 article (01/2016)
9.	Wirth, S: 1 article (01/2016)
10.	Grimm, A: 1 article (01/2016)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Intrinsic Positive-Pressure Respiration:

1.	OxygenIBA 11/01/1999 - "Auto-PEEP levels and cardiac index should be monitored to ensure tissue oxygen delivery is maintained." 05/01/2009 - "For the first time ever, oxygen saturation was measured continuously during the initial situation, during self-performed positive end-expiratory pressure breathing (auto-PEEP) itself, and during observation afterwards. " 09/01/1993 - "In all modes, the inspiratory oxygen fraction, tidal volume, respiratory rate, and total positive end-expiratory pressure (PEEPt = applied PEEP + intrinsic PEEP) were kept constant. " 11/01/2002 - "The paper presents the results of a study of the impact of autoPEEP (positive end-expiratory pressure) on gas exchange in the lungs, their biomechanical characteristics, the transport and consumption of oxygen by inverting the inspiration/expiration ratio under the volume-controlled mechanical ventilation of the lung (VCMVL) in patients with acute parenchymatous lung lesion, as well as how to choose the optimum inspiration/expiration ratio in VCMVL by analyzing the pattern of total PEEP (the sum of positioning and autoPEEP) in this group of patients." 06/01/2015 - "Intensive care unit patients may have a compensated and asymptomatic relative hypovolemia that can be decompensated by a small amount of auto-PEEP produced by air trapping during insufflating oxygen (O2) through a 7.0 endotracheal tube (ETT). "
2.	Isoflurane FDA LinkGeneric 11/01/1994 - "Indices of respiratory resistance as well as the magnitude of dynamic hyperinflation and intrinsic PEEP improved considerably with isoflurane administration, after having been refractory to intensive conventional bronchodilator therapy. "
3.	FenoterolIBA 01/01/1990 - "We conclude that: 1) intrinsic PEEP can be present in stable COPD patients due to increased airflow resistance; 2) fenoterol improved diaphragmatic strength (Pdi,max) in our COPD patients, possibly due to a decrease in lung volume."
4.	PS 5 (PS-5)IBA 11/01/1995 - "During PSb and PSb + 5 and to a lesser extent during PSb-5, most of the patients made several inspiratory efforts that were not efficient enough to trigger the ventilator to inspire; thus, the PTPdi "wasted" during these inefficient efforts was increased, especially during PS + 5. The application of an external PEEP (PEEPe) of 75% of the static intrinsic PEEP during PSb caused a significant reduction in the occurrence of these inefficient efforts (p < 0.05). "
5.	Carbon MonoxideIBA 05/01/1997 - "We conclude that IRV at a ratio that results in a significant intrinsic PEEP does not improve Pa(O2), enhances CO2 elimination, decreases cardiac output (CO), and does not exert any time-dependent effect." 01/01/2000 - "It is critical to monitor the adverse effects (triggering, auto-PEEP [positive end expiratory pressure], air trapping, and patient comfort) created by the additional flow introduced into the ventilator circuit, while balancing the CO (2) clearance. " 04/01/2002 - "Assuming that central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP) are adequate estimates of the volume of the systemic and pulmonary circulation respectively, the following decision tree is suggested: 1) make a working diagnosis based on the relationship between pressure (CVP and PAOP) and cardiac output or stroke volume (CO or SV); 2) consider conditions that may alter reliability of CVP and PAOP in estimate adequately circulating volumes such as abnormal pressure/volume relationship (compliance) of the RV or LV, increased intrathoracic pressure (PEEP, autoPEEP, intra-abdominal pressure), valvular heart disease (mitral stenosis); 3) look at the history; 4) separating RV and LV by reciprocal variations of CVP, PAOP and SV. "
6.	Albuterol (Salbutamol)FDA LinkGeneric 07/01/1991 - "No significant changes were observed in the breathing pattern, intrinsic PEEP or arterial blood gas measurements after albuterol, and peripheral cardiovascular effects were not significant. " 09/01/2005 - "In 10 anesthetized, mechanically ventilated, and bronchodilator-responsive COPD patients exhibiting moderate intrinsic PEEP (PEEPi), we assessed respiratory system (rs) mechanics, hemodynamics, and gas exchange at (a) baseline (zero PEEPe [ZEEPe]), (b) 30 min after 5 mg of nebulized salbutamol administration (ZEEPe-S), (c) 30 min after setting PEEPe at baseline PEEPi level (PEEPe), and (d) 30 min after 5 mg of nebulized salbutamol administration with PEEPe maintained unchanged (PEEPe-S). "
7.	Ipratropium (Ipratropium Bromide)FDA LinkGeneric 01/01/1994 - "The combination of both drugs produced significantly reduction in Pei and auto-PEEP when compared with ipratropium bromide alone. "
8.	Ketamine FDA LinkGeneric 07/01/1988 - "Respiratory mechanics and intrinsic PEEP during ketamine and halothane anesthesia in young children."
9.	Halothane (Fluothane)FDA Link 07/01/1988 - "Respiratory mechanics and intrinsic PEEP during ketamine and halothane anesthesia in young children."
10.	Carbon DioxideIBA 12/01/1999 - "Effective carbon dioxide removal can be achieved by applying a ventilation mode that creates auto PEEP and not by a mode that applies the same level of PEEP by static PEEP only."

Therapies and Procedures

1.	Positive-Pressure Respiration (PEEP) 05/01/1996 - "However, the large variations in regional lung compliance make it improbable that an optimal external PEEP level beneficial for the whole lung will be found; 4) using intrinsic PEEP in the inverse ratio ventilation (IRV) mode which varies with differences in regional ventilatory kinetics. " 07/01/2000 - "These results show that P0.1t may help to assess the effects of PEEP in patients with intrinsic PEEP." 01/01/1997 - "This animal study compares external PEEP with intrinsic PEEP in pressure- and volume-controlled ventilation. " 10/01/1995 - "During all trials with applied PEEP, local lung unit EEP was equal to applied PEEP, whereas during auto-PEEP local EEP differed (p < 0.01). " 11/01/1994 - "In the study conditions, PEEP application up to values approaching auto-PEEP did not result in the impairment of right ventricular hemodynamics, while higher levels reduced cardiac output in selected patients."
2.	Continuous Positive Airway Pressure 05/01/1996 - "No clinical study has yet convincingly demonstrated the benefit of IRV compared to conventional ventilation, controlled clinical long-term trials are not yet available; and 5) using superimposed spontaneous breathing which may be considerably more effective in opening up collapsed alveoli, combined with intentional intrinsic PEEP this is achieved in airway pressure release ventilation (APRV). " 02/01/2001 - "The continuous positive airway pressure (CPAP) mode offers the least intrinsic PEEP during insertion of the catheter and least sub-atmospheric pressure during suctioning." 06/01/1990 - "The purpose of this study was to offset the auto-PEEP in patients with exacerbated chronic airflow obstruction by applying continuous positive airway pressure via the nose [nasal-CPAP]. " 11/01/1995 - "Effect of continuous positive airway pressure (CPAP) in patients with chronic obstructive pulmonary disease (COPD) depending on intrinsic PEEP levels." 01/01/1996 - "Continuous positive airway pressure (CPAP) is helpful for patients with decreased lung compliance, airways obstruction due to vocal cord paralysis or tracheobronchomalacia, presence of auto-PEEP (positive end-expiratory pressure) and as a weaning method. "
3.	Mechanical Ventilators (Ventilator) 01/01/2015 - "In the latter ventilator modes, Peso measurement allows one to assess a patient's respiratory effort, patient-ventilator asynchrony, intrinsic PEEP and the calculation of work of breathing. " 11/01/2012 - "Settings of respirators have to be aimed at a reduction of intrinsic PEEP and dynamic hyperinflation. " 02/01/2012 - "Neurally adjusted ventilatory assist, a novel strategy of ventilatory assist, may improve patient-ventilator interaction in patients with auto-PEEP." 02/01/2012 - "In patients who trigger the ventilator or who are not connected to a ventilator, auto-PEEP can be estimated by simultaneous recordings of airflow and airway and esophageal pressure, respectively. " 01/01/2012 - "In this paper, a platform for automatic detection of AutoPEEP based on the flow signal available on most of recent mechanical ventilators is introduced. "
4.	Intensive Care (Surgical Intensive Care) 07/01/1990 - "Every patient receiving ventilation was evaluated for controlled ventilation and auto-PEEP in medical and surgical intensive care units during a 3-month period. " 03/01/1993 - "While several mechanisms of improved gas exchange have been postulated, many intensive care physicians believe that the development of occult PEEP (autoPEEP; intrinsic PEEP) leads to the observed rise in oxygen saturation. "
5.	Artificial Respiration (Mechanical Ventilation) 02/01/2012 - "In patients receiving controlled mechanical ventilation, auto-PEEP can be estimated measuring the rise in airway pressure during an end-expiratory occlusion maneuver. " 01/01/2012 - "Automatic detection of AutoPEEP during controlled mechanical ventilation." 10/01/2011 - "When performing interventional bronchoscopy during mechanical ventilation, the inside diameter of larynx mask and tracheal intubation should be as large as possible to minimize airway pressure and auto-PEEP." 10/01/2010 - "Successful weaning from mechanical ventilation, successful SBT, reintubation and intrinsic PEEP. " 06/01/2005 - "Auto-PEEP can potentially interfere with weaning from mechanical ventilation. "