Positive expiratory pressure

Several devices are also available to promote airway clearance. Flutter valve devices employ oscillating positive expiratory pressure (OPEP) to cause vibratory air flow obstruction and an internal percussive effect to mobilize secretions. Intrapulmonary percussive ventilation (IPV) provides continuous oscillating pressures during inhalation and exhalation. Finally the most commonly used technique is high-frequency chest compression (HFCC) with an inflatable vest that provides external oscillation. Vest therapy is often preferred by patients because they can independently perform the therapy even from an early age.5,14... 

Steam inhalation and cough suppressants may relieve upper airway symptoms, sore throat, nonproductive cough, and hoarseness. Appropriate antibiotic therapy should only be instituted following confirmation of infection by positive sputum tests (Gram stain and culture). Intubation should be accomplished prior to the development of laryngeal spasm or edema so that adequate ventilation is established and suction of necrotic and inflammatory debris can be facilitated. Oxygen may be required as well. Early use of positive expiratory pressure (PEEP) or... 

Figure 6 PEP device with a mouthpiece. Abbreviation-. PEP, positive expiratory pressure.

Langenderfer B. Alternatives to percussion and postural drainage. A review of mucus clearance therapies percussion and postural drainage, autogenic drainage, positive expiratory pressure, flutter valve, intrapulmonary percussive ventilation, and high-frequency chest compression with the ThAIRapy Vest J Cardiopulm Rehabil 1998 18(4) 283-289. 

Darbee JC, Kanga JF, Ohtake PJ. Physiologic evidence for high-frequency chest wall oscillation and positive expiratory pressure breathing in hospitalized subjects with cystic fibrosis. Phys Ther 2005 85(12) 1278-1289. 

Patients have an exaggerated preload dependence. Blood pressure may decrease in response to diuretics, nitroglycerin, morphine, and/or positive end expiratory pressure (PEEP)... 

Oxygen/positive end expiratory pressure (PEEP)/intubation as needed... 

PEEP Positive end-expiratory pressure QOL Quality of life... 

Aerosol - Some subjects requiring assisted ventilation have experienced serious difficulties because of inadequate ventilation and gas exchange. Drug precipitation within the ventilatory apparatus, including the endotracheal tube, has resulted in increased positive and expiratory pressure and increased positive inspiratory pressure. Accumulation of fluid in tubing ( rain out ) also has been noted. 

The animals are intubated via cannulation of the trachea with an 18-gage metal tube and ventilated (Harvard pump ventilator) at a tidal volume of 0.4 mL, frequency 120 breaths/min and positive end-expiratory pressure 2.5-3.0 cm H20. 

YES OXYGEN, positive end-expiratory pressure Drain vesicles—unroof large blisters and irrigate area with... 

In addition to the effects of anesthetic agents themselves, other intraoperative interventions may also influence renal function. The initiation of mechanical ventilation, especially with the application of positive end-expiratory pressure, is associated with decreases in... 

Jarnberg PO,deVillota ED, EkIundJ, Gran berg PO. Effects of positive end-expiratory pressure on renal function. Acta Anaesthesiol Scand 1978 22(5) 508-14. 

PEEP positive end-expiratory pressure RXR retenoic orphan receptor... 

W. A. C. Mutch, S. H. Harm, G. R. Lefevre, M. R. Graham, L. G. Girling, and S. E. Kowalski, Biologically variable ventilation increases arterial oxygenation over that seen with positive end-expiratory pressure alone in a porcine model of acute respiratory distress syndrome. Crit. Care Med. 28, 2457-2464 (2000). 

For aerosol inhalation, the complete lack of useful clinical experience leaves one to speculate based on animal studies or human poisoning from comparable chemical agents. The first priorities should be immediate evacuation and decontamination to reduce the risks of further exposure or secondary aerosols for the patient and health care provider, combined with providing adequate ventilation and any necessary airway support. Pulmonary edema likely wiU evolve during the 12-36 h following exposure, and this may be amenable to treatment with antiinflammatory drugs, bronchodilators, oxygen, endotracheal intubation, and, in extreme cases, continuous or mechanical supplemental positive end-expiratory pressure (Franz and Jaax, 1997 Audi et al., 2005). 

PEEP Positive end-expiratory pressure positive pressure at the end of exhalation designed to prevent alveoli from collapsing during expiration. 

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