• Lluís Blanch, Francesca Bernabé, and Umberto Lucangelo.
• Critical Care Center, Hospital de Sadabell, Institut Universitari Fundaciò Parc Taulì, Corporaciò Parc Taulì, Universitad Autònoma de Barcelona, Sadabell, Spain. lblanch@cspt.es
• Resp Care. 2005 Jan 1;50(1):110-23; discussion 123-4.

AbstractSevere 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.

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