# PEEP vs. CPAP, are they the same?



## mikie (Apr 5, 2011)

Well, is it?  This was brought up in class recently.  Teacher said no.  

My rationale: They both exert >10cmH20 (though PEEP would be more titratable in certain situations) of pressure within a closed ventilator circuit, preventing atelecastsis, maintaining open alveoli and keeping extrastitial fluid within the vasculature (or out of the alveoli at least).  Am I wrong?  Don't they use the same physical & mechanical means of achieving these goals?

Is it more of semantics for the "indications" of the two?

Thoughts?

Some sources: 
http://www.ccmtutorials.com/rs/mv/page14.htm

http://en.wikipedia.org/wiki/Positive_end-expiratory_pressure_valve

http://en.wikipedia.org/wiki/Mechanical_ventilation


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## MrBrown (Apr 5, 2011)

Browns answer is yes but that PEEP is positive end expiratory pressure, whereas CPAP is continuous positive pressure so it's active over the entire respiratory cycle.


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## usalsfyre (Apr 5, 2011)

Something tells me your teacher doesn't need to be teaching mechanical ventilation...

In essence, yes, they are. Generally in EMS one is thought of as invasive and the other non-invasive. Hopefully usafmedic45 will swing by and give an educated explanation.


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## 18G (Apr 5, 2011)

Generally speaking yes they are the same. CPAP produces PEEP continuously throughout both phases of ventilation. PEEP by itself as set on a ventilator or with a PEEP valve on a BVM, is just what the name implies... end-expiratory and not continuous.


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## MSDeltaFlt (Apr 5, 2011)

5cmH2O is 5cmH2O whether it has a rate or not. It is the amount of pressure above zero to move water 5cm.  They would stick some corregated tubing into a jar and measure off 5cm, 10cm, etc.  Then they would turn on the flowmeter and measure.  Back in the old days.

PEEP is CPAP with a rate.  They are the same thing.


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## usafmedic45 (Apr 5, 2011)

The ten cent rule is PEEP is when someone is receiving mechanically derived breaths, while CPAP is what is happening when the patient is strictly breathing solely on their own.  Otherwise, at least for our intents and purposes, they are physiologically the same thing. 



> My rationale: They both exert >10cmH20 (though PEEP would be more titratable in certain situations) of pressure within a closed ventilator circuit, preventing atelecastsis, maintaining open alveoli and keeping extrastitial fluid within the vasculature (or out of the alveoli at least).



The pressure isn't always "10 cm H2O".  The setting should be titrated to the clinical situation and the patient.  10cm H2O is not enough in some cases, but way too much in others.  If someone is telling you that it's "10 cm H2O" all the time, they have their head crammed pretty far up their ***.


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## Melbourne MICA (Apr 7, 2011)

*iCKY wICKY*



mikie said:


> Well, is it?  This was brought up in class recently.  Teacher said no.
> 
> My rationale: They both exert >10cmH20 (though PEEP would be more titratable in certain situations) of pressure within a closed ventilator circuit, preventing atelecastsis, maintaining open alveoli and keeping extrastitial fluid within the vasculature (or out of the alveoli at least).  Am I wrong?  Don't they use the same physical & mechanical means of achieving these goals?
> 
> ...


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## Shishkabob (Apr 7, 2011)

Kind of... but not really.


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## 8jimi8 (Apr 10, 2011)

I would say.  ALL PEEP is CPAP, not all CPAP is PEEP.


Kind of like squares and rectangles, eh?


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