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Comment
. 2021 Feb 1;203(3):392-394.
doi: 10.1164/rccm.202009-3641LE.

Reply to Mezidi et al.: Assessment of Airway Closure and Expiratory Airflow Limitation to Set Positive End-Expiratory Pressure in Morbidly Obese Patients with Acute Respiratory Distress Syndrome

Aditi Balakrishna  1   2 , Raffaele Di Fenza  1   2 , Caio C A Morais  1 , David A Imber  1   2 , Pankaj Arora  3 , Robert M Kacmarek  1   2 , Roberta De Santis Santiago  1 , Lorenzo Berra  1
Affiliations
Comment

Reply to Mezidi et al.: Assessment of Airway Closure and Expiratory Airflow Limitation to Set Positive End-Expiratory Pressure in Morbidly Obese Patients with Acute Respiratory Distress Syndrome

Aditi Balakrishna et al. Am J Respir Crit Care Med. .
No abstract available

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Figures

Figure 1.
Figure 1.
Case 1: Continuous recording of esophageal pressure (centimeters of water), airway pressures (centimeters of water), and invasive arterial pressure (millimeters of mercury) during the recruitment maneuver (RM) and positive end-expiratory pressure (PEEP) titration by the Lung Rescue Team is shown. Note that the driving pressure decreased from 17 cm H2O (baseline) to 10 cm H2O after the RM, suggesting lung recruitment. Doses of intravenous inotropic-vasopressor medications were unchanged before, during, and after RM and PEEP titration. The doses of inotropic-vasopressor medications were as follows: epinephrine, 5 μg/min; norepinephrine, 33 μg/min; phenylephrine, 25 μg/min; and vasopressin, 0.04 U/min. After 2 hours at 23 cm H2O of PEEP, epinephrine and phenylephrine were stopped, norepinephrine was decreased to 25 μg/min, and vasopressin was unchanged. After 4 hours, norepinephrine was decreased further to 21 μg/min, and vasopressin was unchanged. Case 2: CO (L/min), stroke volume (SV; ml/min) (both measured by transpulmonary thermodilution), MAP (millimeters of mercury), and PEEP (centimeters of water) before, during, and after the Lung Rescue Team intervention are shown. Open circles indicate CO values. Solid circles indicate SV values. Intravenous inotropic-vasopressor medication requirements before the RM were as follows: epinephrine, 3 μg/min; norepinephrine, 50 μg/min; and vasopressin, 0.08 U/min. Epinephrine was reduced to 2 μg/min during alveolar recruitment because of systemic hypertension. After 2 and 4 hours at 20 cm H2O of PEEP, epinephrine was decreased to 1 μg/min, and norepinephrine and vasopressin were unchanged (50 μg/min and 0.08 U/min, respectively). CO = cardiac output; MAP = mean arterial pressure.
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