Ranieri V M, Grasso S, Fiore T, Giuliani R
Istituto di Anestesiologia e Rianimazione, Ospedale Policlinico, Università di Bari, Italy.
Clin Chest Med. 1996 Sep;17(3):379-94. doi: 10.1016/s0272-5231(05)70322-1.
PEEP is indicated in patients with COPD only to unload the respiratory muscles from the auto-PEEP resulting from expiratory flow limitation. If auto-PEEP is not caused by flow limitation, application of PEEP will cause further hyperinflation, worsening respiratory mechanics, muscle activity, and hemodynamics. To assess the presence of expiratory flow limitation correctly, to measure auto-PEEP correctly, and to identify the maximal PEEP level to be used, measurements of flow and opening pressure must be obtained during a brief period of suspended respiratory muscle activity (obtained by sedation) with the patient's own breathing pattern reproduced accurately.
仅在慢性阻塞性肺疾病（COPD）患者中，为了减轻因呼气流量受限导致的内源性呼气末正压（auto-PEEP）对呼吸肌的负荷时才使用呼气末正压（PEEP）。如果内源性呼气末正压不是由流量受限引起的，应用呼气末正压会导致进一步的肺过度充气，使呼吸力学、肌肉活动和血流动力学恶化。为了正确评估呼气流量受限的存在，正确测量内源性呼气末正压，并确定要使用的最大呼气末正压水平，必须在短暂的呼吸肌活动暂停期间（通过镇静获得），准确再现患者自身呼吸模式的情况下获取流量和开口压力的测量值。
