What is a common hemodynamic downside of excessive PEEP?

• A. Reduced venous return, potential hypotension.
• B. Increased venous return, potential hypertension.
• C. No hemodynamic effect.
• D. Decreased mean airway pressure.

Answer: (A)

Excessive PEEP raises intrathoracic pressure, which tightens the pressure surrounding the heart and great veins. That higher intrathoracic pressure reduces venous return to the right heart, meaning less blood fills the heart (lower preload). As a result, cardiac output can fall and blood pressure may drop, making hypotension a common hemodynamic downside. The idea of increased venous return doesn’t fit the physiology of high PEEP, and while PEEP does raise mean airway pressure, saying it decreases it would be incorrect.