PT - JOURNAL ARTICLE AU - Lluís Blanch AU - Francesca Bernabé AU - Umberto Lucangelo TI - Measurement of Air Trapping, Intrinsic Positive End-Expiratory Pressure, and Dynamic Hyperinflation in Mechanically Ventilated Patients DP - 2005 Jan 01 TA - Respiratory Care PG - 110--124 VI - 50 IP - 1 4099 - http://rc.rcjournal.com/content/50/1/110.short 4100 - http://rc.rcjournal.com/content/50/1/110.full AB - Severe airflow obstruction is a common cause of acute respiratory failure. Dynamic hyperinflation affects tidal ventilation, increases airways resistance, and causes intrinsic positive end-expiratory pressure (auto-PEEP). Most patients with asthma and chronic obstructive pulmonary disease have dynamic hyperinflation and auto-PEEP during mechanical ventilation, which can cause hemodynamic compromise and barotrauma. Auto-PEEP can be identified in passively breathing patients by observation of real-time ventilator flow and pressure graphics. In spontaneously breathing patients, auto-PEEP is measured by simultaneous recordings of esophageal and flow waveforms. The ventilatory pattern should be directed toward minimizing dynamic hyperinflation and auto-PEEP by using small tidal volume and preserving expiratory time. With a spontaneously breathing patient, to reduce the work of breathing and improve patient-ventilator interaction, it is crucial to set an adequate inspiratory flow, inspiratory time, trigger sensitivity, and ventilator-applied PEEP. Ventilator graphics are invaluable for monitoring and treatment decisions at the bedside.