Auto-PEEP / dynamic hyperinflation

Start with the expiratory flow-time scalar, then assess hemodynamics and measure total PEEP only when the maneuver is valid.

Recognize the patternExpiratory flow or volume fails to return to baseline.Check hemodynamicsDynamic hyperinflation can reduce venous return and cause shock.Expiratory holdMeasure total PEEP in a passive patient without a major leak.Increase expiratory timeLower RR, shorten Ti/increase flow, and reduce VT if appropriate.Treat obstructive physiologyAsthma/COPD/bronchospasm pathway.

Evidence and use limits

Last reviewed: 2026-07-23. Designed for: emergency medicine learners, clinicians, EMS, RT, and airway educators.

This is an educational cognitive aid, not a bedside order set. Confirm medications, ventilator changes, pediatric dosing, procedures, and escalation decisions against the patient’s physiology, the ventilator in use, and local ED/ICU/anesthesia/pharmacy/RT/EMS/pediatric policy.

Full references · Editorial policy · AARC 2024 ventilator assessment · ATS/ESICM/SCCM lung-protective ventilation · ATS 2024 ARDS update

About this resource

Created by: Andrew Pirotte, MD; Kyle Brown, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: Clinical review pending: local ED, ICU, EMS, anesthesia, pharmacy, and pediatric protocol review recommended before bedside teaching rollout. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: kybrown@kumc.edu