Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 21 , ISSUE 5 ( May, 2017 ) > List of Articles

CASE REPORT

Titration of ideal positive end-expiratory pressure in acute respiratory distress syndrome: Comparison between lower inflection point and esophageal pressure method using volumetric capnography

Nandakishore Baikunje

Keywords : Acute respiratory distress syndrome, esophageal balloon, lower inflection point, optimal positive end-expiratory pressure, transpulmonary pressure

Citation Information : Baikunje N. Titration of ideal positive end-expiratory pressure in acute respiratory distress syndrome: Comparison between lower inflection point and esophageal pressure method using volumetric capnography. Indian J Crit Care Med 2017; 21 (5):322-325.

DOI: 10.4103/ijccm.IJCCM_11_17

License: CC BY-ND 3.0

Published Online: 01-05-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

The tenets of mechanical ventilation in acute respiratory distress syndrome (ARDS) include the utilization of low tidal volume and optimal application of positive end-expiratory pressure (PEEP). Optimal PEEP in ARDS is characterized by reduction in alveolar dead space along with improvement in the lung compliance and resultant betterment in oxygenation. There are various methods of setting PEEP in ARDS. Herein, we report a patient of ARDS, wherein we employed measurement of dead space using volumetric capnography to compare two different PEEP strategies, namely, the lower inflection point and transpulmonary pressure monitoring.


PDF Share
  1. Sehgal IS, Dhooria S, Behera D, Agarwal R. Acute respiratory distress syndrome: Pulmonary and extrapulmonary not so similar. Indian J Crit Care Med 2016;20:194-7.
  2. Sehgal IS, Agarwal R. Non-invasive ventilation in acute respiratory distress syndrome: Helmet use saves lives? Ann Transl Med 2016;4:349.
  3. Suter PM, Fairley B, Isenberg MD. Optimum end-expiratory airway pressure in patients with acute pulmonary failure. N Engl J Med 1975;292:284-9.
  4. Verscheure S, Massion PB, Verschuren F, Damas P, Magder S. Volumetric capnography: Lessons from the past and current clinical applications. Crit Care 2016;20:184.
  5. Talmor D, Sarge T, Malhotra A, O′Donnell CR, Ritz R, Lisbon A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med 2008;359:2095-104.
  6. Talmor D, Sarge T, O′Donnell CR, Ritz R, Malhotra A, Lisbon A, et al. Esophageal and transpulmonary pressures in acute respiratory failure. Crit Care Med 2006;34:1389-94.
  7. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998;338:347-54.
  8. Villar J, Kacmarek RM, Pérez-Méndez L, Aguirre-Jaime A. A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: A randomized, controlled trial. Crit Care Med 2006;34:1311-8.
  9. Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004;351:327-36.
  10. Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, et al. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: A randomized controlled trial. JAMA 2008;299:637-45.
  11. Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med 2006;354:1775-86.
  12. Suarez-Sipmann F, Bohm SH, Tusman G. Volumetric capnography: The time has come. Curr Opin Crit Care 2014;20:333-9.
  13. Tusman G, Groisman I, Fiolo FE, Scandurra A, Arca JM, Krumrick G, et al. Noninvasive monitoring of lung recruitment maneuvers in morbidly obese patients: The role of pulse oximetry and volumetric capnography. Anesth Analg 2014;118:137-44.
  14. Böhm SH, Maisch S, von Sandersleben A, Thamm O, Passoni I, Martinez Arca J, et al. The effects of lung recruitment on the phase III slope of volumetric capnography in morbidly obese patients. Anesth Analg 2009;109:151-9.
  15. Fengmei G, Jin C, Songqiao L, Congshan Y, Yi Y. Dead space fraction changes during PEEP titration following lung recruitment in patients with ARDS. Respir Care 2012;57:1578-85.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.