PEEP titration (VCV) bedside tool, v1.4

Author: Prof. J Kirtania. Decision-support heuristic using Cstat, ΔP, Cdyn, SpO₂/FiO₂ and MAP. Use with clinical context. For reliable Cstat/ΔP, patient should be passive and plateau pressure reliable.

Decremental limb hysteresis (derecruitment trigger)
Quick-entry (adds one row). Enter values at a given PEEP after stabilization.
Recommendation —
Add at least 2 PEEP steps to generate a recommendation.
    PEEP Cstat ΔP Cdyn SpO₂ FiO₂ MAP Action
    Cdyn is treated as supportive trend only (airway resistance can confound it). Primary mechanics are via Cstat and ΔP.
    About & Help (tap to expand)

    Purpose
    This bedside tool supports PEEP titration during volume-controlled ventilation (VCV) using Cstat, ΔP, Cdyn (trend only), SpO₂ (%), and MAP to guide a physiologic balance between lung recruitment, oxygenation, lung protection, and hemodynamic safety.

    Clinical Goal
    Achieve adequate recruitment of lung units to maximize oxygenation at the lowest effective FiO₂ and PEEP, while avoiding overdistension, excessive driving pressure, and circulatory compromise.

    How to Use (Quick Steps)

    • Use only in passive patients on VCV with reliable plateau pressures.
    • Select Incremental or Decremental (post-recruitment) PEEP workflow.
    • Set safety limits (MAP, ΔP).
    • At each PEEP (after stabilization), enter PEEP, Cstat, ΔP, SpO₂/FiO₂, MAP (Cdyn optional).
    • Review the best-tested PEEP and safety flags.
    • Reassess after changes in sedation, recruitment, fluids/vasopressors, or clinical status.

    Important Notes

    • Cdyn is supportive only; do not titrate PEEP on Cdyn alone.
    • Interpret outputs with ABGs, imaging, and bedside assessment.
    • Recommendations apply only to the PEEP levels tested.
    License and Medical Disclaimer
    Software License: GNU GPL v3. Copyright (C) [2025] [Prof. Jyotirmay Kirtania]. This program is free software: you can redistribute it and/or modify it under the terms of the GNU General Public License as published by the Free Software Foundation, either version 3 of the License, or (at your option) any later version. This program is distributed in the hope that it will be useful, but WITHOUT ANY WARRANTY; without even the implied warranty of MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the GNU General Public License for more details. Medical Disclaimer (Cognitive Assist & Record Keeping). IMPORTANT: PLEASE READ CAREFULLY BEFORE USE. NOT A MEDICAL DEVICE: This tool is a Clinical Decision Support System (CDSS) intended for educational and cognitive assistance purposes only. It has not been cleared or approved by the FDA, EMA, or any other regulatory body for use as a primary medical device. NO SUBSTITUTE FOR CLINICAL JUDGMENT: This tool is designed to assist, not replace, the clinical judgment of qualified healthcare professionals. All calculations and logic must be independently verified against institutional standards before clinical application. DATA PRIVACY: This tool is designed to run locally on the user's device. No data is transmitted to external servers by the software. The user is solely responsible for ensuring that the use of this tool complies with local patient data privacy laws (e.g., HIPAA, GDPR) and institutional IT policies. LIMITATION OF LIABILITY: In no event shall the authors or copyright holders be liable for any claim, damages, or other liability, whether in an action of contract, tort, or otherwise, arising from, out of, or in connection with the software or the use or other dealings in the software.