PEEP Valves and Diverters

[@1381432]

Finally someone with a nice explanation! thanks

[@aki-chan2243]

Wow, thanks a lot for this. Very helpful to use to explain the installation of different valves❤

[@pavelivanov8894]

Thx for your job George! Its very useful.

[@Petrosilius]

Thank you, best explanation! Love from Germany ❤

[@CPRPrepCourses]

Great teacher! The presentation was organized and succinct

[@GeorgeORRT]

Thanks

[@ห้องอุบัติเหตุเกาะลันตา]

very helpful! thank you so much

[@Betterdays1717]

Great video

[@josephineh4391]

Thank you so much, this is very helpful!!!

[@albertstc]

Many thanks George

[@juanschott]

Thank you very much from Argentine...in my ambulance nobody knows what for they are those things...

[@Suzi_P]

Great explanation! Thank you for teaching.

[@GeorgeORRT]

Hi: Glad that it was of value to you.

[@croaker260]

I am curious why you do not want PEEP in BVM ventilation. Here in the States, we are commonly using PEEP with a BVM. We also use a Manometer as standard and several methods for rate control and improved mask seal.

[@GeorgeORRT]

Hi Steve: We also use pressure valves and encourage restraint from bagging vigorously or too aggressively during resuscitation (BVM). We don't use PEEP though when bagging (BVM) to prevent gas from accumulating in the stomach possibly leading to distension and aspiration......if your using 5-8 cmH2O (or higher) when bagging, that same pressures is applied in the esophagus and stomach. PEEP is applied once the artificial airway is placed/confirmed in the proper position.

[@latestlatest4760]

hi, George..I would like to ask if there is any difference between the BVM's PEEP valve and the ventilator's PEEP valve?And is it true that, when we are talking about Positive Pressure Ventilation , either BVM or Ventilator, there's actually no difference between PEEP and CPAP?thank you.

[@GeorgeORRT]

Hi: PEEP is the official name used when we mechanically ventilate a patient with a "mechanical" breath such as a delivered breath with a BVM or a fully supported vent delivered breath. CPAP is the exact same thing but it applies to spontaneously breathing patients that may be breathing from a BVM device or triggering spontaneous breaths from a vent as your trying to wean them off the vent. The principles of PEEP and CPAP are identical but the differentiation is in the type of breath the patient gets.....fully supported = PEEP. Patient initiated, partially supported (maybe).... = CPAP.

[@latestlatest4760]

@@GeorgeORRT thanks George for replying. That makes it a lot clearer. But If I may ask you again, because I am still confuse about this a bit. So,if they are actually the same thing, why is the pressure-time scalar in CPAP machine display different than when we use PEEP valve with BVM (converting the BVM into a poor-man CPAP)? I mean, with a real CPAP machine, we will see a straight line above zero(positive pressure) as the baseline of our breath, on the other hand, CPAP with BVM (by using the PEEP valve), we can see that the end-exp pressure will stay positive only at expiration, but not when inspiration. Why is that?thank you🙏

[@sinclair657]

Thank you

[@atefredwan5183]

Excellent

[@gabrielvidalgomez]

have a doubt about the peep hook on the laerdal i really dont understand if the peep goes outside of the airway sistem with the attachment how the positive pressure is made, Different with ambu peep goes into the airway system, can u please explain

[@hardford1]

Is there any valve can be installed to control plateau pressre and pip on ambubag?

[@rickw4160]

the bag should have either an adjustable or manual overide.

[@vikinipl634]

Hey George, I wanted to know when the peep valve (set on 5) is attached to ambu, and the lungs are inflated, when we stop further inflation, does the peep remains 5 constant on its decreases slowly

[@GeorgeORRT]

Hi: PEEP should remain constant at what you have it set to with a closed system. A closed system means that there are no leaks between the ventilator or bagger (Ambu) and the patient's lungs. PEEP will drop or become zero if you remove the bagger, have a leak between the mask and patient's face, detach the ventilator circuit, or have a leak around the ETT or airway cuff etc.

[@wgtsui]

Hello, Is it necessary to use peep during CPR? If I use peep during CPR, what should peep amount be, set at?

[@GeorgeORRT]

Only use PEEP after the patient is intubated and the airway secured. the amount used would be based on any underlying illness the patient has.

[@wgtsui]

@@GeorgeORRT thanks for replying

[@supreetkamatagi1831]

Hi, on what parameters will decide while choosing the PEEP valve and how to choose PEEP valve is this really required

[@GeorgeORRT]

Remember that you should never use peep without an ETT or TT or alternate airway in place. PEEP levels used are based on the patients overall condition (including hemdynamics, cardiac function) as well as oxygenation. Typically, you may start PEEP @ 5-6 cmH2O and then titrate up if oxygenation is refractory. Pay attention to cardiac functions, especially acute drops in BP as that could imply too high of a PEEP level. Also pay attention to PIP and possible drops in delivered volumes especially if your ventilator is not PEEP compensated.

[@narwhalsintheocean9745]

@@GeorgeORRT This is an interesting point. Would you want to avoid using peep in a code? There's really no way to get BP when working a code (I'm thing prehospital), so would applying peep potentially reduce cardiac output due to the extra pressure that may be exerted on the heart? Similar to how CPAP can cause a drop in BP?

[@GeorgeORRT]

@@narwhalsintheocean9745 Yes, your are correct. Increasing thoracic pressures via PEEP/CPAP will reduce decrease venous return. If a patient is cardiac compromised there's likely to be a drop in BP once pressures become too high. PEEP levels should be used cautiously and attention focused on drops in BP. Its recommended that PEEP be used in a code once the ETT is correctly placed in the patients trachea to avoid gastric distention in the patient's esophagus and stomach.

[@MChell87]

Really great explanation, informative and to the point. Quick question, what would happen if you didn't have the diverter or the PEEP valve on the Ambu bag? I had a patient that self extubated and I grabbed the Ambubag available at the bedside but noticed there was no PEEP valve or diverter on it. (Patient did fine btw on noninvasive Bipap)

[@GeorgeORRT]

Hi: You're better off not having the PEEP valve on the BVM (resuscitator) with BVM resuscitation as the PEEP applied could also lead to gastric insufflation and distension that could lead to tracheal/lung aspiration. Best to add PEEP once the artificial airway (ETT) has been inserted and the cuff is up. Hope this helps

[@GeorgeORRT]

HI: We don't use PEEP when bagging (BVM) to prevent gas from accumulating in the stomach possibly leading to distension and aspiration......if your using 5-8 cmH2O (or higher) when bagging, that same pressures is applied in the esophagus and stomach. PEEP is applied once the artificial airway is placed/confirmed in the proper position. Not having the PEEP valve or diverter on the Ambu setup you used may or may not have made a difference to patient care...if anything, it probably helped prevent some distension when you used the Ambu. That being said, please ensure you adhere to the policies and procedures of your institution. George O. RRT

[@foramshethia8147]

WHICH PEEP VALVE IS NEEDED FOR AMBU?

[@GeorgeORRT]

I think that I have a video on how to attach the peep valves for the laerdal as well as ambu variety manual resuscitators. If not, pull the diverter tube (that's the clear pliable plastic part where the exhaled gases leave the bagger) off the bagger and attach a standard peep valve. If it doesn't properly connect, you may need an adaptor.

[@foramshethia8147]

Hello I want to which types of peep valves and diverters are needed for the ambu ventilation? The name of peep valve and diverters

[@yudhvirgupta9510]

Mri

[@yudhvirgupta9510]

principles of mri

[@yudhvirgupta9510]

Principles of MRI

[@rupakkundu535]

thanks

[@عبدالعزيزالصالحي-ه3ك]

What the job of PeeP valve

[@GeorgeORRT]

To keep the lungs distended during exhalation thereby keeping the alveoli opening and improving gas exchange and promoting oxygenation.

[@ing.ricardofarias2051]

Hello George I am developing an ambu bag manipulator and want to use it as a respiratory aid, but want to add peep adjustment would be awesome if you could check the design at my channel and tell me what could be improved based on your expertise.

[@narwhalsintheocean9745]

This comment section is very wholesome

[@szarmanckijezozwierz2801]

what does it means?

[@bren2232]

How is a PEEP level decided?

[@GeorgeORRT]

Hi: PEEP levels are determined by the medical condition the patient presents with and the need for them to be ventilated. Different pathologies require different starting PEEP levels or in some cases, no PEEP. It all depends on why your ventilating them in the first place. Typical starting points for PEEP are 5-6 cmH2O or slightly higher.