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Research ArticleOriginal Research

Evaluation of Esophageal Pressures in Mechanically Ventilated Obese Patients

Guramrinder Singh Thind, Eduardo Mireles-Cabodevila, Robert L Chatburn and Abhijit Duggal
Respiratory Care February 2022, 67 (2) 184-190; DOI: https://doi.org/10.4187/respcare.08978
Guramrinder Singh Thind
Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
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  • For correspondence: [email protected]
Eduardo Mireles-Cabodevila
Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
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Robert L Chatburn
Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
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Abhijit Duggal
Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
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Abstract

BACKGROUND: Patients who are obese are at risk for developing high pleural pressure, which leads to alveolar collapse. Esophageal pressure (Pes) can be used as a surrogate for pleural pressure and can be used to guide PEEP titration. Although recent clinical data on Pes-guided PEEP has shown no benefit, its utility in the subgroup of patients who are obese has not been studied.

METHODS: The Medical Information Mart for Intensive Care-III critical care database was queried to gather data on Pes in subjects on mechanical ventilation. Pes in obese and non-obese groups were compared, and a subgroup analysis was performed in subjects with class III obesity. Thereafter, empirical and Pes-guided PEEP protocols of a recently published trial were theoretically applied to the obese group and ventilator outcomes were compared.

RESULTS: A total of 105 subjects were included in the study. The average end-expiratory Pes in the obese group was 18.8 ± 5 cm H2O compared with 16.8 ± 4.8 cm H2O in the non-obese group (P < .05). If Pes-guided PEEP protocol was to be applied to those in the obese group, then the PEEP setting would be significantly higher than empirical PEEP setting. These findings were accentuated in the subgroup of subjects with class III obesity.

CONCLUSIONS: Individualization of PEEP with Pes guidance may have a role in patients who are obese.

  • Pleural pressure
  • esophageal pressure
  • obesity
  • mechanical ventilation
  • PEEP
  • respiratory failure

Footnotes

  • Correspondence: Guramrinder Singh Thind MD, Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44915. E-mail: thindg{at}ccf.org
  • Mr Chatburn discloses relationships with IngMar Medical, Vyaire Medical, Inovytec, and Promedic LLC. The other authors have disclosed no conflicts of interest.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (2)
Respiratory Care
Vol. 67, Issue 2
1 Feb 2022
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Evaluation of Esophageal Pressures in Mechanically Ventilated Obese Patients
Guramrinder Singh Thind, Eduardo Mireles-Cabodevila, Robert L Chatburn, Abhijit Duggal
Respiratory Care Feb 2022, 67 (2) 184-190; DOI: 10.4187/respcare.08978

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Evaluation of Esophageal Pressures in Mechanically Ventilated Obese Patients
Guramrinder Singh Thind, Eduardo Mireles-Cabodevila, Robert L Chatburn, Abhijit Duggal
Respiratory Care Feb 2022, 67 (2) 184-190; DOI: 10.4187/respcare.08978
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Keywords

  • Pleural pressure
  • esophageal pressure
  • obesity
  • mechanical ventilation
  • PEEP
  • respiratory failure

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