Managing Hypercapnia in Patients with Severe ARDS and Low Respiratory System Compliance: The Role of Esophageal Pressure Monitoring—A Case Cohort Study

<div>Representative pressure tracing of patient number 5. End expiratory transpulmonary (EETP) pressure is positive at 10.2 cm H<sub>2</sub>O. In this example, lowering PEEP closer towards zero decreased EETP pressure and resulted in a marked improvement in tidal volume and PaCO<sub>2</sub>. <svg height="12.4067pt" id="M38" style="vertical-align:-3.408751pt" version="1.1" viewbox="-0.0498162 -8.99795 22.458 12.4067" width="22.458pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z" id="g113-81"></path><glyph.data ascent="3473" descent="-2876" horiz-adv-x="617" vert-adv-y="617"></glyph.data></g><g transform="matrix(.0095,0,0,-0.0095,6.937,3.264)"><path d="M673 0V28C608 34 594 43 563 129C499 303 432 494 370 665L339 656L132 132C98 43 84 37 20 28V0H238V28C162 35 154 45 175 108C188 150 203 192 219 237H432C454 176 474 122 487 83S491 36 428 28V0H673ZM418 280H234C265 362 296 450 328 535H330L418 280Z" id="g190-66"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="691" vert-adv-y="691"></glyph.data></g><g transform="matrix(.0095,0,0,-0.0095,12.566,3.264)"><path d="M956 650H736V622C814 613 818 602 804 542C789 471 733 275 691 141H689C628 314 570 476 514 641H485C434 478 377 312 323 142H321C277 284 238 419 199 554C184 605 186 613 259 622V650H16V622C77 615 92 606 117 524C172 346 228 170 281 -11H312C363 151 419 312 475 488H477C528 343 597 150 652 -11H683C765 269 826 458 848 522C878 605 887 613 956 622V650Z" id="g190-88"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="971" vert-adv-y="971"></glyph.data></g></svg>: airway pressure, <svg height="12.4448pt" id="M39" style="vertical-align:-3.446851pt" version="1.1" viewbox="-0.0498162 -8.99795 17.4795 12.4448" width="17.4795pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z" id="g113-81"></path><glyph.data ascent="3473" descent="-2876" horiz-adv-x="617" vert-adv-y="617"></glyph.data></g><g transform="matrix(.0095,0,0,-0.0095,6.937,3.264)"><path d="M517 162C503 123 484 88 467 68C445 42 417 34 341 34C291 34 256 34 237 47C219 59 213 81 213 128V317H308C395 317 402 311 415 240H444V431H415C403 364 398 356 307 356H213V584C213 613 215 616 246 616H322C394 616 421 609 435 587C448 566 458 544 467 502L496 506C493 557 488 625 488 650H42V622C120 616 128 612 128 523V125C128 43 120 35 29 28V0H511C520 31 540 125 546 158L517 162Z" id="g190-70"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="568" vert-adv-y="568"></glyph.data></g><g transform="matrix(.0095,0,0,-0.0095,12.323,3.264)"><path d="M409 504C401 567 396 607 392 642C354 654 312 665 266 665C137 665 60 583 60 487C60 374 161 325 225 290C300 250 355 215 355 141C355 68 311 21 235 21C131 21 86 122 71 183L41 176C48 128 61 42 68 21C78 16 93 8 118 0C142 -7 175 -15 216 -15C349 -15 438 69 438 174C438 287 344 333 265 374C186 414 138 449 138 522C138 576 172 631 249 631C336 631 363 562 380 499L409 504Z" id="g190-84"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="474" vert-adv-y="474"></glyph.data></g></svg>: esophageal pressure, and <svg height="12.3115pt" id="M40" style="vertical-align:-3.31355pt" version="1.1" viewbox="-0.0498162 -8.99795 18.7931 12.3115" width="18.7931pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z" id="g113-81"></path><glyph.data ascent="3473" descent="-2876" horiz-adv-x="617" vert-adv-y="617"></glyph.data></g><g transform="matrix(.0095,0,0,-0.0095,6.937,3.264)"><path d="M592 498C586 556 582 629 581 675H560C545 656 537 650 510 650H115C87 650 74 652 60 675H40C38 620 33 555 28 495H57C69 539 77 568 89 585C102 607 122 616 205 616H267V123C267 44 259 34 168 28V0H454V28C360 34 352 44 352 123V616H422C498 616 514 608 531 584C542 568 552 543 562 495L592 498Z" id="g190-85"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="617" vert-adv-y="617"></glyph.data></g><g transform="matrix(.0095,0,0,-0.0095,12.788,3.264)"><path d="M46 650V622C120 617 128 613 128 525V125C128 42 120 34 40 28V0H311V28C221 34 212 39 212 124V281L286 262C297 261 316 261 331 263C429 275 526 338 526 468C526 533 501 579 462 609C422 638 364 650 293 650H46ZM212 559C212 588 215 600 223 606C230 613 251 618 279 618C361 618 430 572 430 464C430 337 350 302 285 302C252 302 225 309 212 314V559Z" id="g190-81"></path><glyph.data ascent="989" descent="-360" horiz-adv-x="563" vert-adv-y="563"></glyph.data></g></svg>: transpulmonary pressure.</div>

BioMed Research International

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Figure 5

Figure 5: Managing Hypercapnia in Patients with Severe ARDS and Low Respiratory System Compliance: The Role of Esophageal Pressure Monitoring—A Case Cohort Study 

Figure 5 | Managing Hypercapnia in Patients with Severe ARDS and Low Respiratory System Compliance: The Role of Esophageal Pressure Monitoring—A Case Cohort Study 