This study aimed to empirically assess the extent to which flow limitation alone explains a "complete PEEP-absorber" behavior (i.e., absence of further hyperinflation with PEEP), and to identify other factors associated with it. From a pathophysiological perspective, all subjects with flow limitation are expected to be "complete PEEP-absorbers," whereas PEEP should increase total PEEP in all other patients. We refer to these patients as "complete PEEP-absorbers." Conversely, adverse effects of PEEP application could occur in patients with auto- PEEP when the total PEEP rises as a consequence. In some patients with auto-positive end-expiratory pressure (auto- PEEP), application of PEEP lower than auto- PEEP maintains a constant total PEEP, therefore reducing the inspiratory threshold load without detrimental cardiovascular or respiratory effects. Natalini, Giuseppe Tuzzo, Daniele Rosano, Antonio Testa, Marco Grazioli, Michele Pennestrì, Vincenzo Amodeo, Guido Berruto, Francesco Fiorillo, Marialinda Peratoner, Alberto Tinnirello, Andrea Filippini, Matteo Marsilia, Paolo F Minelli, Cosetta Bernardini, Achille Effect of external PEEP in patients under controlled mechanical ventilation with an auto- PEEP of 5 cmH2O or higher.
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