Incorporating electrical impedance tomography to transpulmonary pressure-guided PEEP in severe ARDS with pneumothorax and multiple cavitations: a case report.

在严重的 ARDS 合并气胸和多个空洞的情况下 ， 将电阻抗断层扫描结合到经肺压力引导的 PEEP 中 ： 一例。

• 影响指数: 5.058
• 发表时间: 2023
• 来源期刊: Front Med (Lausanne)
• DOI: 10.3389/fmed.2023.1240321
• PMID: 37700773
• 文章类型: Case Reports
• 作者列表: Wang Q,Su L,Jiang J,Wang N,He H,Long Y

关键词: ARDS; EIT; MRSA pneumonia; positive end-expiratory pressure; transpulmonary pressure

Abstract

Pneumothorax is a potentially fatal complication in patients with acute respiratory distress syndrome (ARDS), presenting challenges in determining the optimal positive end-expiratory pressure (PEEP) level to prevent atelectasis without exacerbating the pneumothorax. This case report describes the successful application of transpulmonary pressure and electrical impedance tomography (EIT) at the bedside to guide PEEP selection in a patient with ARDS complicated by pneumothorax due to methicillin-resistant Staphylococcus aureus infection. By using minimal PEEP to maintain positive end-expiratory transpulmonary pressure and visualizing lung reopening with EIT, the optimal PEEP level was reaffirmed, even if traditionally considered high. The patient\'s condition improved, and successful weaning from the ventilator was achieved, leading to a transfer out of the intensive care unit. Clinical trial registration: https://clinicaltrials.gov/show/NCT04081142, identifier NCT04081142.

摘要

气胸是急性呼吸窘迫综合征（ARDS）患者的潜在致命并发症，在确定最佳呼气末正压（PEEP）水平以预防肺不张而不加剧气胸方面存在挑战。该病例报告描述了在床边成功应用经肺压力和电阻抗断层扫描（EIT）来指导因耐甲氧西林金黄色葡萄球菌感染而并发气胸的ARDS患者的PEEP选择。通过使用最小的PEEP来维持呼气末正经肺压，并通过EIT观察肺部重新开放，重申了最佳PEEP水平，即使传统上被认为很高。病人的病情好转,成功地从呼吸机上断奶，导致转出重症监护室。临床试验注册：https://clinicaltrials.gov/show/NCT04081142，标识符NCT04081142。