The increased work of breathing associated with auto-positive end expiratory pressure (PEEP) during mechanical ventilation is due to:
1. Hyperinflation or impaired contractility of the diaphragm.
2. Large alveolar pressure drops required to trigger breaths.
3. Increased volume of the intrathoracic airways.
a. 1 and 2 only
b. 1 and 3 only
c. 2 and 3 only
d. 1, 2, and 3
ANS: A
First, hyperinflation caused by auto-PEEP stretches the lung, and the stretching impairs the con-tractile action of the diaphragm. Second, in pressure- or flow-triggered breaths, the high alveolar pressure caused by auto-PEEP must be overcome before any airway pressure change can occur.
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