Test your IntelliVence (Vol 18 Issue 5)

15.11.2021
Author: Justin Seemueller, Respiratory Clinical Specialist, Sentara Norfolk General Hospital, Reviewer: Munir Karjaghli, Süha Demirakca

This high-BMI patient is receiving mechanical ventilation in Pressure Control (PCMV) with an esophageal balloon in place. What was done to lower this patient’s PEEP requirement to maintain a positive Ptranspulm gradient at end-exhalation?

Pes = 16.8
Pes = 13.0

Answer: Increased bed angle

In high-BMI patient populations, elevated pleural pressure is often caused by increased weight being pressed against the diaphragm. By increasing the bed angle, tissue can be offloaded to reduce pleural pressure. It is a common strategy to target a positive Ptranspulm at end-exhalation to reduce VILI caused by the cyclic opening and closing of ventilatory lung units.

Ptranspulm = Paw – Pes

In this case, Pes was reduced from 16.8 to 13.0 by increasing the bed angle. As a result, it was possible to lower PEEP from 24 to 21 and still maintain a similar expiratory Ptranspulm pressure.

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Date of Printing: 30.06.2022
Disclaimer:
The content of this newsletter is for informational purposes only and is not intended to be a substitute for professional training or for standard treatment guidelines in your facility. Any recommendations made in this newsletter with respect to clinical practice or the use of specific products, technology or therapies represent the personal opinion of the author only, and may not be considered as official recommendations made by Hamilton Medical AG. Hamilton Medical AG provides no warranty with respect to the information contained in this newsletter and reliance on any part of this information is solely at your own risk.
Date of Printing: 30.06.2022
Disclaimer:
The content of this Knowledge Base is intended for informational purposes only. Medin Medical AG provides no warranty with respect to the information contained in this Knowledge Base and reliance on any part of this information is solely at your own risk. For detailed instructions on operating your Medin Medical device, please refer to the official Medin Medical Operator’s Manual for the respective device.