What is positive pressure ventilation (PPV)?

From the Guidelines

Positive pressure ventilation (PPV) is a mechanical breathing support technique that delivers air into the lungs by applying positive pressure, forcing air into the lungs during inspiration, and includes both continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) as described in the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 1.

Key Components of PPV

• PPV is used to decrease respiratory distress and reduce the rate of mechanical endotracheal intubation in patients with acute heart failure (AHF) and respiratory distress 1.
• Non-invasive PPV, including CPAP and BiPAP, should be considered in patients with respiratory distress (respiratory rate >25 breaths/min, SpO2 <90%) and started as soon as possible 1.
• BiPAP allows inspiratory pressure support that improves minute ventilation and is especially useful in patients with hypercapnia, most typically chronic obstructive pulmonary disease (COPD) patients 1.

Clinical Applications

• PPV is commonly used in intensive care settings, during surgery, and for patients with respiratory failure.
• In AHF, oxygen therapy is recommended in patients with SpO2 <90% or PaO2 <60 mmHg (8.0 kPa) to correct hypoxaemia, and PPV can be used to reduce respiratory distress and improve oxygenation 1.
• The fraction of inspired oxygen (FiO2) should be increased up to 100% if necessary, according to SpO2, unless contraindicated, and hyperoxia should be avoided 1.

Important Considerations

• Non-invasive PPV can reduce blood pressure and should be used with caution in hypotensive patients, with regular monitoring of blood pressure 1.
• Intubation is recommended if respiratory failure, leading to hypoxaemia, hypercapnia, and acidosis, cannot be managed non-invasively 1.
• Regular assessment of ventilator settings, patient comfort, and weaning readiness is essential for optimal management of PPV.

From the Research

Definition of Positive Pressure Ventilation (PPV)

• Positive Pressure Ventilation (PPV) is a mode of mechanical ventilation that improves gas exchange and can improve cardiovascular hemodynamics by reducing preload and afterload of the left ventricle, reducing mitral regurgitation and decreasing myocardial oxygen demand 2.
• PPV is often used in patients with cardiogenic shock, acute respiratory distress syndrome, and other respiratory failures.

Mechanism of PPV

• PPV works by delivering air into the lungs at a pressure higher than the atmospheric pressure, which helps to keep the alveoli open and improve oxygenation 2.
• The use of PPV can also help to reduce the risk of volutrauma and atelectrauma by stabilizing alveolar recruitment 3.

Ventilator Settings for PPV

• The optimal ventilator settings for PPV, including tidal volume and positive end-expiratory pressure (PEEP), should be personalized for each patient based on their lung mechanics and respiratory parameters 4, 3.
• The setting of PEEP and tidal volume should be based on sound physiologic bedside measures, such as the potential for lung recruitment and the risk of overdistension 3.

Clinical Applications of PPV

• PPV is commonly used in intensive care units to support patients with respiratory failure, including those with cardiogenic shock and acute respiratory distress syndrome 2, 5.
• The use of PPV can help to improve patient outcomes by reducing the risk of respiratory complications and improving cardiovascular hemodynamics 2.