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Awareness of gas trapping in patients with airflow obstruction was commonplace before the initial description of auto-PEEP, but its development during mechanical ventilation and implications for cardiopulmonary management were not generally understood.
APRV raises mean airway pressure higher than standard ventilation; foregoes tight control over true maximal trans-alveolar pressure; and deliberately generates unmeasured and variable levels of auto-PEEP.
Danger also lurks for those with severe airflow obstruction who vary their levels of breathing effort and auto-PEEP.
When the lungs are passively inflated, the reasons that mean airway pressure must rise in parallel with VE are two-fold: First, because expiration is driven only by passive recoil of the respiratory system, average lung volume must rise as minute ventilation and mean expiratory flow do; Second, auto-PEEP may be generated by reduced expiratory time.
Current respiratory care practitioners (RCPs) may find it hard to believe that dynamic hyperinflation and auto-PEEP remained clinically unrecognized long after the era of positive pressure ventilation had begun.
The increased triggering threshold caused by auto-PEEP can be counteracted by increasing the set PEEP by 1 cm [H.