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

Figure 4

Representative pressure tracing of patient number 3. Inspiratory driving pressure was increased from 15 to 25 cm H₂O. Although plateau pressure increased from 28.5 to 38 cm H₂O, end inspiratory transpulmonary (EITP) pressure did not exceed 18.2 cm H₂O (lower pressure tracing). The increased EITP pressure resulted in a marked improvement in alveolar ventilation and consequent reduction in PaCO₂ from 99 to 53 mmHg, while at the same time keeping EITP pressure well within acceptable limits. : airway pressure, : esophageal pressure, and : transpulmonary pressure.