Abstract
During mechanical ventilation for acute respiratory distress syndrome, tidal volume (VT) must be reduced. Once switched to pressure-support ventilation, there is a risk that uncontrolled large VT may be delivered. A 63-year-old man with community-acquired pneumonia required tracheal intubation and mechanical ventilation, with a VT of 6 mL/kg predicted body weight, PEEP of 10 cm H2O, a respiratory rate of 30 breaths/min, and FIO2 of 0.60. Plateau pressure was 22 cm H2O. He improved and received pressure-support. Twelve days later a chest radiograph showed suspected air leaks, confirmed via computed tomogram (CT), which showed anterior pneumomediastinum. VT received over the previous 3 days had averaged 14 mL/kg predicted body weight. The patient was put back onto volume-controlled mode, and 2 days later there were no air leaks. In pressure-support ventilation, VT must be closely monitored to ensure lung-protective mechanical ventilation.
- acute respiratory distress syndrome
- ARDS
- ventilator-induced lung injury
- mechanical ventilation
- volutrauma
Footnotes
- Correspondence: Claude Guérin MD PhD, Service de Réanimation Médicale, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France. E-mail: claude.guerin{at}chu-lyon.fr.
The authors have disclosed no conflicts of interest.
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