mhi and peep

thoughts on manual hyperinflation for patients on moderately high peep (i'm thinking 8-10cmh2o)??

some say yes use a peep valve, but others argue if they're that peep dependent then they shouldn't be disconnected and you could do manual breaths on the ventilator.

your practice?

with increasing peep, the peak expiratory flow rate reduces, so the effectiveness of mh as a modality to mobilize secretions also reduces.

reference:
www.anesthesia-analgesia....100/4/1112