scholarly journals Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome

2021 ◽  
Vol 3 (10) ◽  
pp. e0555
Author(s):  
Tariq A. Dam ◽  
Harm-Jan de Grooth ◽  
Thomas Klausch ◽  
Lucas M. Fleuren ◽  
Daan P. de Bruin ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Ventilator Settings

scholarly journals Use of Transpulmonary Pressure Monitoring in the Management of Extrapulmonary Pediatric Acute Respiratory Distress Syndrome With multi organ dysfunction syndrome (MODS): Are We Peepophobic?

2019 ◽  
Vol 12 ◽  
pp. 117954761984218 ◽  
Author(s):  
Mukul Pandey ◽  
Dhiren Gupta ◽  
Neeraj Gupta ◽  
Anil Sachdev
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Transpulmonary Pressure ◽  
Esophageal Pressure ◽  
Positive End Expiratory Pressure ◽  
Pressure Monitoring ◽  
Ventilator Settings ◽  
The Ideal

Manipulation of positive end-expiratory pressure (PEEP) has been shown to improve the outcome in pediatric acute respiratory distress syndrome (PARDS), but the “ideal” PEEP, in which the compliance and oxygenation are maximized, while overdistension and undesirable hemodynamic effects are minimized, is yet to be determined. Also, for a given level of PEEP, transpulmonary pressure (TPP) may vary unpredictably from patient to patient. Patients with high pleural pressure who are on conventional ventilator settings under inflation may cause hypoxemia. In such patients, raising PEEP to maintain a positive TPP might improve aeration and oxygenation without causing overdistension. We report a case of PARDS, who was managed using real-time esophageal pressure monitoring using the AVEA ventilator and thereby adjusting PEEP to maintain the positive TPP.

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