When using a volume-pressure loop, where along the loop is the optimum PEEP level determined?

A. at the bottom of the inspiratory limb as inflation begins
B. at the top of the inspiratory limb as inflation is about to end
C. at the point of maximum curvature on the upper portion of the deflation limb
D. at the point of end-expiration


ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: The goal of PEEP therapy is to engage recruitable alveoli while avoiding lung overdistention of healthy alveoli. To optimize the effect of PEEP while using the least amount of pressure, PEEP settings can be integrated with a recruitment maneuver, which takes the lung to full inflation, and maximally recruits all the recruitable alveoli. The resultant PEEP setting then occurs on the deflation portion of the pressure-volume relationship at the point of maximum curvature.
D. Incorrect response: See explanation C.

Health Professions

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