Strategies for Preventing and Treating Auto-PEEP

38680A 32-year-old female diagnosed with asthma exacerbation and impending respiratory failure is admitted to the emergency department. Her breathing is labored with a respiratory rate of 40 and a heart rate of 150. Twenty minutes after admission the patient was intubated with a 7.5mm endotracheal tube (ETT).
One hour after admission her condition worsened. Her vital signs and assessment findings revealed the following: hypotensive with a Blood Pressure 82/50, heart rate 170, respiratory rate 60, breath sounds diminished. The patient was placed on the ventilator with the following settings: Assist Control mode (AC), Tidal Volume 500 ml, Respiratory Rate 12, FiO2 100%, Positive end-expiratory pressure (PEEP) 5.
The first ventilator check noted the following data: Peak Inspiratory Pressure (PIP) 50 cmH2O, Plateau Pressure Pplat) 32 cmH2O, Auto-PEEP 15 cmH2O.
Based on the scenario above, do you feel that a patient diagnosed with asthma predisposes them to developing Auto-PEEP? Why or why not? Based on the ventilator settings ordered by the physician, do you feel they are appropriate for this patient? What initial ventilator settings or changes would you recommend and why?
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