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Auto-PEEP Explained: Breath Stacking, Air Trapping, and Mechanical Ventilation

WBM Emergency & Critical Care

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Auto-PEEP, breath stacking, and air trapping are important mechanical ventilation concepts that can increase work of breathing, impair hemodynamics, and complicate ventilator management. In this video, we review the physiology of auto-PEEP, how air trapping develops, how to recognize breath stacking on ventilator waveforms, and practical bedside strategies for management.

Topics covered include:
• What auto-PEEP is
• Intrinsic PEEP versus set PEEP
• Breath stacking explained
• Air trapping physiology
• Expiratory flow limitation
• Obstructive lung disease and auto-PEEP
• Ventilator waveform findings
• Flow-time scalar clues
• Hemodynamic effects of auto-PEEP
• Increased work of breathing
• Triggering difficulty
• Dynamic hyperinflation
• Measuring auto-PEEP
• Ventilator adjustments to reduce air trapping
• Practical bedside management approach

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⚠️ Educational Disclaimer:
This content is intended for educational purposes only and should not be used as a substitute for clinical judgment, institutional protocols, specialist consultation, or individualized patient care.
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#AutoPEEP
#MechanicalVentilation
#BreathStacking
#CriticalCare
#MedicalEducation

12 Comments

@WBMECC Creator 2 years ago (edited) Pinned

📚 Want to go deeper on advanced mechanical ventilation — auto-PEEP, breath stacking, and air trapping?
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Built for medical students, residents, nurses, RTs, and physicians looking to improve clinical confidence and bedside decision-making.

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**MECHANICAL VENTILATION SERIES**
https://youtube.com/playlist?list=PLf5bMa9_tvRgVjd6EYdHBcLnIiCTgGKD9&si=LDYqNjDRNIDh6ZCn

@LynVivo-i2t 7 months ago

I'm an RT student, I'll be graduating this May, I've been watching your videos to review some mechanical vent concepts. Thank you for your videos, you are really good at explaining complex topics!

@randyhoffmann7426 2 years ago

11:46 Did you misspeak here when you said prolonged expiratory times cause breath-stacking or am I missing something?
Nonetheless, fantastic video with plenty good info! Sincerely, a Respiratory Therapist that is trying to brush up on Intrinsic PEEP again 😄

@zulqarnainsurwa4310 9 months ago

Very well explained concept thank you appreciated

@TrueIndian9999 10 months ago

Hello...nice ,concise video...thanks👍

@iancolas8031 1 year ago

Great video

@sinclair657 2 years ago

Thank you

@shevonforbes9826 2 years ago (edited)

Can you do a video on how to fix sensitivity on the ventilator what’s the purpose of sensitive when to identify it n fix it in the vent

@shevonforbes9826 2 years ago

Can you do more videos on missed trigger, double trigger,

@Ghita1532 2 months ago

❤❤❤

@guapodesperado2822 2 years ago

Couple of questions.

First, 30 breaths per minutes seems way too much, wouldn't this keep the patient in an extreme state of physical tension. Seems to me longer slower deeper breathing would stimulate healing much better. Such fast breathing would likely increase risk of lung injury and hypertension, would it not? Healthy, calm people don't breathe once every two seconds. 5 to 6 breaths a minute creates far more calm and healing. Slower breathing allows for breathing deeper into the alveoli, while rapid breathing tends to be shallow, with less gas exchange.

Second, if this is such a problem, why hasn't someone invented a ventilation device that monitors the air volume in and out and has the ability to help gently draw out any remaining unexhaled air volume prior to the next ventilation input? Seems to me, with modern technology, this should be possible.