High PEEP extubation as guided by esophageal manometry

Kathryn M Pendleton; Jacob Fiocchi; Julia Meyer; Alexandra Fuher; Sarah Green; William M LeTourneau; Ronald A Reilkoff

doi:10.1016/j.rmcr.2024.101985

High PEEP extubation as guided by esophageal manometry

Respir Med Case Rep. 2024 Jan 23:48:101985. doi: 10.1016/j.rmcr.2024.101985. eCollection 2024.

Authors

Kathryn M Pendleton¹, Jacob Fiocchi², Julia Meyer³, Alexandra Fuher³, Sarah Green⁴, William M LeTourneau⁵, Ronald A Reilkoff¹

Affiliations

¹ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
² Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
³ University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA.
⁴ MHealth-Fairview Southdale Hospital, Edina, MN, USA.
⁵ Department of Anesthesiology and Perioperative Medicine, Respiratory Therapy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.

Abstract

The ventilatory management of morbidly obese patients presents an ongoing challenge in the Intensive Care Unit (ICU) as multiple physiologic changes in the respiratory system complicate weaning efforts and make extubation more difficult, often leading to increased time on the ventilator. We report the case of a young adult male who presented to our ICU on two separate occasions with hypoxemic respiratory failure requiring intubation. Esophageal manometry (EM) guided positive end expiratory pressure (PEEP) titration was utilized during both ICU admissions to improve oxygenation and aid in extubation with spontaneous breathing trials performed on higher-than-normal PEEP settings and successful liberation on both occasions.

Keywords: Esophageal manometry; Morbid obesity; Obese; Positive end expiratory pressure (PEEP); Spontaneous breathing trials (SBT); Ventilator weaning.

Publication types

Case Reports