Which of the following is the most appropriate PEEP level for the patient whose information is in the table below?
Time 0140 1050 0155 0200 0205 0210
PEEP (cm H2O) 5 8 10 12 15 18
CO (L/min) 3.5 3.5 3.6 3.6 3.2 3.2
Mixed ve-nous PO2 (mm Hg) 28 39 43 45 42 27
BP 140/90 133/90 124/90 120/80 115/78 100/70
a. 10 cm H2O
b. 12 cm H2O
c. 15 cm H2O
d. 18 cm H2O
ANS: B
At a PEEP of 12 cm H2O, the cardiac output is at its highest level (3.6 L/min), and the mixed venous PO2 is at its highest level. This correlates with an enhancement in cardiac performance. However, at a PEEP of 15 cm H2O, both these indices, as well as the blood pressure, are re-duced, meaning that the alveoli are overdistended and the point of optimum PEEP is no longer present.
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