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• W2084836226 abstract "Purpose . Patients with severe acute respiratory distress syndrome (ARDS) and hypercapnia present a formidable treatment challenge. We examined the use of esophageal balloon for assessment of transpulmonary pressures to guide mechanical ventilation for successful management of severe hypercapnia. Materials and Methods . Patients with severe ARDS and hypercapnia were studied. Esophageal balloon was inserted and mechanical ventilation was guided by assessment of transpulmonary pressures. Positive end expiratory pressure (PEEP) and inspiratory driving pressures were adjusted with the aim of achieving tidal volume of 6 to 8 mL/kg based on ideal body weight (IBW), while not exceeding end inspiratory transpulmonary (EITP) pressure of 25 cm H 2 O. Results . Six patients with severe ARDS and hypercapnia were studied. Mean PaCO 2 on enrollment was<mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML id=M1><mml:mn>108.33</mml:mn><mml:mo>±</mml:mo><mml:mn>25.65</mml:mn></mml:math> mmHg. One hour after adjustment of PEEP and inspiratory driving pressure guided by transpulmonary pressure, PaCO 2 decreased to<mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML id=M2><mml:mn>64.5</mml:mn><mml:mo>±</mml:mo><mml:mn>16.89</mml:mn></mml:math> mmHg (<mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML id=M3><mml:mi>P</mml:mi><mml:mo><</mml:mo><mml:mn>0.01</mml:mn></mml:math>). Tidal volume was<mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML id=M4><mml:mn>3.96</mml:mn><mml:mo>±</mml:mo><mml:mn>0.92</mml:mn></mml:math> mL/kg IBW before and increased to<mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML id=M5><mml:mn>7.07</mml:mn><mml:mo>±</mml:mo><mml:mn>1.21</mml:mn></mml:math> mL/kg IBW after intervention<mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML id=M6><mml:mo stretchy=false>(</mml:mo><mml:mi>P</mml:mi><mml:mo><</mml:mo><mml:mn>0.01</mml:mn><mml:mo stretchy=false>)</mml:mo></mml:math>. EITP pressure before intervention was low with a mean of<mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML id=M7><mml:mn>13.68</mml:mn><mml:mo>±</mml:mo><mml:mn>8.69</mml:mn></mml:math> cm H 2 O and remained low at<mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML id=M8><mml:mn>16.76</mml:mn><mml:mo>±</mml:mo><mml:mn>4.76</mml:mn></mml:math> cm H 2 O (<mml:math xmlns:mml=http://www.w3.org/1998/Math/MathML id=M9><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.18</mml:mn></mml:math>) after intervention. Adjustment of PEEP and inspiratory driving pressures did not worsen oxygenation and did not affect cardiac output significantly. Conclusion . The use of esophageal balloon as a guide to mechanical ventilation was able to treat severe hypercapnia in ARDS patients." @default.
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• W2084836226 date "2015-01-01" @default.
• W2084836226 modified "2023-09-27" @default.
• W2084836226 title "Managing Hypercapnia in Patients with Severe ARDS and Low Respiratory System Compliance: The Role of Esophageal Pressure Monitoring—A Case Cohort Study" @default.
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• W2084836226 doi "https://doi.org/10.1155/2015/385042" @default.
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