What is Positive End-Expiratory Pressure (PEEP)?

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Last updated: June 14, 2025 • View editorial policy

From the Guidelines

Positive End-Expiratory Pressure (PEEP) is a ventilation technique that maintains a positive pressure in the airways at the end of exhalation, preventing alveolar collapse, and is typically set between 5-15 cmH2O depending on the patient's condition.

Key Points

  • PEEP works by keeping the alveoli open throughout the respiratory cycle, which improves oxygenation by increasing functional residual capacity and preventing atelectasis 1.
  • The optimal PEEP level should be individualized based on the patient's lung compliance, oxygenation requirements, and hemodynamic stability 2.
  • In conditions like acute respiratory distress syndrome (ARDS), higher PEEP levels (12-15 cmH2O or more) may be needed to improve oxygenation and prevent ventilator-induced lung injury (VILI) 3, 4.
  • Clinicians must monitor for potential adverse effects including decreased cardiac output due to reduced venous return, barotrauma, and pneumothorax when implementing PEEP 2.
  • PEEP can be delivered through mechanical ventilators in intubated patients or via CPAP devices in non-intubated patients 1.

Recommendations

  • Use a low tidal volume (4–6 ml/kg) and low plateau pressure (< 30 cmH2O), and appropriate positive end expiratory pressure (PEEP) for invasive mechanical ventilation in patients with ARDS 4.
  • Consider using higher PEEP levels and prone ventilation for more than 12 h a day along with deep sedative analgesia in the first 48 h of mechanical ventilation for patients with moderate to severe ARDS 4.
  • Individualize PEEP levels based on lung recruitability, end-expiratory transpulmonary pressure, and other factors to optimize lung protection and oxygenation 2.

From the Research

Definition of PEEP

  • Positive End-Expiratory Pressure (PEEP) is a technique used in mechanical ventilation to keep the lungs open at the end of exhalation, improving oxygenation and preventing alveolar collapse 5, 6, 7, 8, 9.

Benefits of PEEP

  • Improves arterial oxygenation by recruiting collapsed alveoli and preventing alveolar collapse at end expiration 5, 6, 7, 8, 9.
  • Reduces tidal lung stress and strain by promoting more homogenous ventilation 9.
  • May improve patient outcomes in acute respiratory distress syndrome (ARDS) by reducing ventilator-induced lung injury 5, 7.

PEEP Titration Strategies

  • Various strategies have been proposed to optimize PEEP titration, including PEEP/FiO2 tables, mechanical parameters, and techniques to assess lung recruitment 9.
  • No single method of PEEP titration has been shown to improve clinical outcomes compared to other approaches 9.

Clinical Applications of PEEP

  • PEEP is commonly used in the management of ARDS, acute lung injury, and other respiratory conditions requiring mechanical ventilation 5, 6, 7, 8, 9.
  • Higher levels of PEEP may be necessary to maintain the lungs open and assure homogenous ventilation in ARDS patients 5, 7.
  • PEEP-induced lung recruitment maneuvers can improve oxygenation and prognosis in patients with moderate to severe ARDS 6.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.