High Positive End-Expiratory Pressure Allows Extubation of an Obese Patient

The patient was successfully extubated to 16 cm H2O continuous positive airway pressure, discharged from the ICU, and eventually discharged from the hospital without the need for reintubation. The elevated pleural pressure in these patients works as a mechanical load, reducing lung volumes and causi...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2018-08, Vol.198 (4), p.524-525
Main Authors: Teggia Droghi, Maddalena, De Santis Santiago, Roberta R, Pinciroli, Riccardo, Marrazzo, Francesco, Bittner, Edward A, Amato, Marcelo B P, Kacmarek, Robert M, Berra, Lorenzo
Format: Article
Language:English
Subjects:
Clinical practice guidelines
Continuous positive airway pressure
Esophagus
Obesity
Patients
Respiratory therapy
Ventilators
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Summary:The patient was successfully extubated to 16 cm H2O continuous positive airway pressure, discharged from the ICU, and eventually discharged from the hospital without the need for reintubation. The elevated pleural pressure in these patients works as a mechanical load, reducing lung volumes and causing airway closure, increased airway resistance, and development of atelectasis, especially within dependent lung regions. Liberation from mechanical ventilation in critically ill adults: an official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: inspiratory pressure augmentation during spontaneous breathing trials, protocols minimizing sedation, and noninvasive ventilation immediately after extubation.
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.201712-2411im