Intrinsic (PEEPi) is a common problem in patients with
COPD leading to asynchrony and needs to recognized
and treated as is associated with weaning failure. PEEPi
has been reportedly higher in COPD patients with
weaning failure as compared to those being successfully
weaned.[27] Multiple mechanisms are responsible for
the development of PEEPi in mechanically ventilated
COPD patients, for example, insufficient expiratory
time for complete emptying of lungs due to increased
airflow resistance with expiratory airflow limitation
and high breathing frequency and promotes patient–
ventilator asynchrony. This leads to ineffective breaths
being triggered, a significant factor for difficult weaning.
A study by de Wit et al. demonstrated significantly
longer duration of MV in patients with more than 10%
ineffective trigger breaths.