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Vent control

Auto-PEEP: hemodynamic effects

Dynamic hyperinflation raises intrathoracic pressure and can sharply reduce venous return.

Hypotension pathwayIf MAP is falling.Fix expiratory timeLower trapping burden.

If crashing

  • Recognize obstructive shock or PEA from dynamic hyperinflation.
  • A brief ventilator disconnect may allow trapped gas to escape while the team manages oxygenation and the underlying obstruction.
  • Reassess for tension pneumothorax, tube obstruction, RV failure, and other causes of shock rather than assuming auto-PEEP.

Evidence and use limits

Last reviewed: 2026-07-17. 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: Emergency medicine faculty review completed. Medication content reviewed by Amanda Vanderwerf, PharmD, BCEMP, and Morgan Kimball, PharmD, BCEMP. 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: [email protected]