Auto-PEEP Expiratory Pause Assessment

Key Points

• Auto-PEEP increases mean airway pressure and can contribute to barotrauma, volutrauma, and hypotension.
• Expiratory pause is used to estimate auto-PEEP during static expiration.
• Continued expiratory flow into tubing during expiratory hold suggests intrinsic pressure trapping.

Equipment

• Mechanical ventilator with expiratory-pause (expiratory hold) capability
• Continuous pressure and flow waveform display
• Hemodynamic monitoring for hypotension surveillance
• Team escalation pathway for ventilator-setting optimization

Procedure Steps

1. Identify clinical need for intrinsic PEEP assessment using waveform trends and patient status.
2. Verify patient safety and monitoring readiness before maneuver.
3. Activate expiratory pause to close expiratory valve during static expiration.
4. Observe for continued airway flow into tubing during hold phase.
5. Recognize lung-ventilator pressure equilibration during pause.
6. Record measured pressure estimate as auto-PEEP value.
7. Correlate value with pressure-injury and hemodynamic risk indicators.
8. Communicate findings and support ordered ventilator adjustments to reduce trapping risk.
9. Repeat assessment after adjustments to confirm improvement.

Common Errors

• Skipping auto-PEEP checks despite waveform concern → delayed recognition of pressure trapping.
• Interpreting measurements without clinical correlation → unsafe over- or under-response.
• Ignoring hypotension during elevated intrinsic pressure → delayed circulatory compromise management.
• Failing to reassess after adjustment → unresolved intrinsic PEEP burden.

Related

• ventilator-waveform-interpretation - Waveform context guides when intrinsic PEEP assessment is needed.
• ventilator-parameter-adjustment-principles - Adjustment strategy follows pressure and gas-exchange findings.