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?
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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