References

Abstract

ventilation has profound hemodynamic consequences. The expiratory airflow obstruction in the ventilator circuit leads to excessive positive pressure during exhalation called the auto-PEEP effect (2). Therefore, the intrinsic PEEP likely greatly exceeded the extrinsic PEEP set on the ventilator. The mechanisms of the hemodynamic consequences of the auto-PEEP effect include reduced cardiac output from diminished venous return and markedly increased pulmonary vascular resistance due to compression of intraalveolar vessels. Acute cor pulmonale is a consequence of this last phenomenon. Fluid loading in the setting of diminished left ventricular compliance from acute cor pulmonale can lead to pulmonary edema (3). Occult auto-PEEP can have significant cardiopulmonary effects. It is an important cause of death among patients treated with mechanical positive pressure ventilation (4)