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BioMed Research International
Volume 2015, Article ID 385042, 9 pages
Clinical Study

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

1Intensive Care Unit, E. Wolfson Medical Center, 62 HaLohamim Street, P.O. Box 5, 58100 Holon, Israel
2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Received 4 August 2014; Revised 1 October 2014; Accepted 13 October 2014

Academic Editor: Yeong Shiong Chiew

Copyright © 2015 Arie Soroksky et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. Patients with severe acute respiratory distress syndrome (ARDS) and hypercapnia present a formidable treatment challenge. We examined the use of esophageal balloon for assessment of transpulmonary pressures to guide mechanical ventilation for successful management of severe hypercapnia. Materials and Methods. Patients with severe ARDS and hypercapnia were studied. Esophageal balloon was inserted and mechanical ventilation was guided by assessment of transpulmonary pressures. Positive end expiratory pressure (PEEP) and inspiratory driving pressures were adjusted with the aim of achieving tidal volume of 6 to 8 mL/kg based on ideal body weight (IBW), while not exceeding end inspiratory transpulmonary (EITP) pressure of 25 cm H2O. Results. Six patients with severe ARDS and hypercapnia were studied. Mean PaCO2 on enrollment was  mmHg. One hour after adjustment of PEEP and inspiratory driving pressure guided by transpulmonary pressure, PaCO2 decreased to  mmHg (). Tidal volume was  mL/kg IBW before and increased to  mL/kg IBW after intervention . EITP pressure before intervention was low with a mean of  cm H2O and remained low at  cm H2O () after intervention. Adjustment of PEEP and inspiratory driving pressures did not worsen oxygenation and did not affect cardiac output significantly. Conclusion. The use of esophageal balloon as a guide to mechanical ventilation was able to treat severe hypercapnia in ARDS patients.