PR10: Positive End Expiratory Pressure
The addition of a Positive End-Expiratory Pressure (PEEP) valve to a bag-valve mask is a non-invasive means of increasing oxygenation in patients who are in significant respiratory distress or respiratory arrest where assisted ventilations are not able to maintain oxygen saturation. It maintains air pressure in the alveoli, “splinting” them open to increase the surface area involved in gas exchange.
- Patients who remain hypoxemic (SpO2 < 90%) despite good bag-valve mask ventilation techniques and airway management; it can be combined with high-flow nasal cannula oxygenation to maximize oxygen delivery
- Patients in cardiac arrest
- Systolic blood pressure ≤ 90 mmHg
- Known or suspected pneumothorax
- Traumatic cause of respiratory arrest
- Attach the PEEP valve to the exhaust port on the bag-valve mask.
- Set the dial on the PEEP valve to 5 cmH2O.
- Establish and maintain a good mask seal. Begin ventilating at an appropriate rate, usually no more than 8-10 breaths per minute.
- Monitor oxygen saturation and blood pressure for changes.
- PEEP may be increased in increments of 2.5 cmH2O to a maximum of 10 cmH2O.
- Continue with medications as appropriate to correct cause of respiratory distress or arrest.