A Case of Patient-Ventilator Dyssynchrony Caused by Inadvertent PEEP

Abstract

Despite years of experience and a plethora of literature regarding manage- ment strategies for mechanically ventilated patients with chronic airflow obstruction (CAO), the resources of health-care providers in the acute care setting continue to be challenged. We report a case demonstrating the successful application of the use of extrinsic positive end-expiratory pressure (PEEPE), to offset inadvertent PEEP (PEEPA) in a patient with CAO. The use of conventional ventilatory strategies in this patient resulted in patient-ventilator dyssynchrony, and repeated attempts at weaning were unsuccessful. We employed esophageal pressure manometry to guide titration of PEEPE up to 15 cm H₂O, which allowed us to stabilize and eventually wean this patient from mechanical ventilatory support. This case demonstrates that the nonconventional use of PEEPE with appropriate monitoring can be beneficial in patients with CAO and PEEPA.