title: Optimization of Mechanical Ventilation in a 31-Year-Old Morbidly Obese Man With Refractory Hypoxemia.
abstract: Morbidly obese, critically ill patients are prone to develop hypoxemic respiratory failure and ventilator dependency. The best method for recruiting the lungs of these patients and keeping alveoli open without causing injury remains unclear. We present the case of a 31-year-old patient with severe refractory hypoxemia reversed by lung recruitment maneuvers and subsequent application of positive end-expiratory pressure (PEEP) at a level determined by a decremental PEEP trial. The patient was extubated at a high PEEP level of 22 cm H2O followed by noninvasive ventilatory support after extubation. This case suggests that a recruitment maneuver followed by PEEP titration is necessary in obese patients for optimizing mechanical ventilation. Extubation to noninvasive ventilatory support with the identified optimal PEEP may decrease an inappropriate increased work of breathing and the risk of reintubation.
authors: From the *Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; †Anesthesia and Operation Center, Chinese PLA General Hospital, Beijing, China; and Departments of ‡Radiology and §Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.
authors: Changsheng
authors: C
authors: Zhang
authors: Massimiliano
authors: M
authors: Pirrone
authors: David A E
authors: DA
authors: Imber
authors: Jeanne B
authors: JB
authors: Ackman
authors: Jacopo
authors: J
authors: Fumagalli
authors: Robert M
authors: RM
authors: Kacmarek
authors: Lorenzo
authors: L
authors: Berra
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D010845:Obesity Hypoventilation Syndrome / Q000150:complications*; D009767:Obesity, Morbid / Q000150:complications*; D018467:Positive-Pressure Respiration, Intrinsic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome