Successful Management of a Patient by Using High-Level PEEP with Intermittent Mandatory Ventilation—A Case Report

Abstract

A middle-aged man developed congestive heart failure and respiratory failure after coronary artery surgery. Mechanical ventilation with ${\text{FI}}_{{\text{O}}_{\text{2}}}$ 0.60 and PEEP of 15 cm H₂O did not arrest pulmonary decline, but the PEEP was ruled out as a cause of deterioration and high PEEP of 30 cm H₂O was tried. Lung compliance, PO₂, and PCO₂ improved with high-level PEEP. To try to avert cardiovascular damage from the high PEEP, IMV was employed to lower mean intrathoracic pressure. Worsened mental status was noted after two days; high PEEP may have caused venous stasis and consequent cerebral edema. PEEP was discontinued after 13 days and the case was brought to a successful conclusion with no apparent residual pulmonary or neurologic dysfunction. It is suggested that the use of high-level PEEP should be accompanied by monitoring of cerebrospinal fluid pressure.