Table 3.

Management of positive end-expiratory pressure (PEEP) based on aetiology of shock

Type of shock	Potential drawback to PEEP	Means of monitoring and compensating
Hypovolemic	↓ RV and LV preload can lead to ↓ CO and worsening of hypotension	Ensure adequate volume resuscitation; carefully monitor BP
Cardiogenic	Although the ↓ LV afterload will ↑CO, the ↓ RV and LV preload may ↓ CO to a greater degree	Ensure that the patient does not have concomitant hypovolaemia
Distributive	↓ RV and LV preload can lead to ↓ CO and worsening of hypotension	Ensure adequate volume resuscitation; carefully monitor BP
Obstructive	↑ RV afterload may precipitously ↓ CO in light of ↓ RV and LV preload	Vigorous hydration and vasopressor support may be necessary to maintain haemodynamic regulation

BP, blood pressure; CO, cardiac output; LV, left ventricular; RV, right ventricular.