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Managing Hypercapnia in Patients with Severe ARDS and Low Respiratory System Compliance: The Role of Esophageal Pressure Monitoring—A Case Cohort Study
Joint Authors
Girsh Solomonovich, Zehava
Tayem, Emad
Gingy Ronen, Balmor
Soroksky, Arie
Rozhavsky, Boris
Kheifets, Julia
Source
Issue
Vol. 2015, Issue 2015 (31 Dec. 2015), pp.1-9, 9 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2015-01-28
Country of Publication
Egypt
No. of Pages
9
Main Subjects
Abstract EN
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 H2O.
Results.
Six patients with severe ARDS and hypercapnia were studied.
Mean PaCO2 on enrollment was 108.33±25.65 mmHg.
One hour after adjustment of PEEP and inspiratory driving pressure guided by transpulmonary pressure, PaCO2 decreased to 64.5±16.89 mmHg (P<0.01).
Tidal volume was 3.96±0.92 mL/kg IBW before and increased to 7.07±1.21 mL/kg IBW after intervention (P<0.01).
EITP pressure before intervention was low with a mean of 13.68±8.69 cm H2O and remained low at 16.76±4.76 cm H2O (P=0.18) 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.
American Psychological Association (APA)
Soroksky, Arie& Kheifets, Julia& Girsh Solomonovich, Zehava& Tayem, Emad& Gingy Ronen, Balmor& Rozhavsky, Boris. 2015. Managing Hypercapnia in Patients with Severe ARDS and Low Respiratory System Compliance: The Role of Esophageal Pressure Monitoring—A Case Cohort Study. BioMed Research International،Vol. 2015, no. 2015, pp.1-9.
https://search.emarefa.net/detail/BIM-1055270
Modern Language Association (MLA)
Soroksky, Arie…[et al.]. Managing Hypercapnia in Patients with Severe ARDS and Low Respiratory System Compliance: The Role of Esophageal Pressure Monitoring—A Case Cohort Study. BioMed Research International No. 2015 (2015), pp.1-9.
https://search.emarefa.net/detail/BIM-1055270
American Medical Association (AMA)
Soroksky, Arie& Kheifets, Julia& Girsh Solomonovich, Zehava& Tayem, Emad& Gingy Ronen, Balmor& Rozhavsky, Boris. Managing Hypercapnia in Patients with Severe ARDS and Low Respiratory System Compliance: The Role of Esophageal Pressure Monitoring—A Case Cohort Study. BioMed Research International. 2015. Vol. 2015, no. 2015, pp.1-9.
https://search.emarefa.net/detail/BIM-1055270
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1055270