USO DE CATÉTER ESOFÁGICO PARA LA VENTILACIÓN MECÁNICA DE UNA PACIENTE CON ALTERACIÓN SEVERA DE LA DISTENSIBILIDAD DE LA PARED TORÁCICA.

REPORTE DE CASO

Abstract

The present case describes the way in which the measurement of transpulmonary pressure was used, through an esophageal catheter, for the titration of mechanical ventilation in a patient who, due to generalized edema of the chest wall, secondary to a failure acute kidney injury, did not allow ventilation with conventional lung protection parameters. The patient presents severe hypoxemic respiratory failure requiring intubation and invasive mechanical ventilation. When tidal volume programming was carried out taking into account the ideal body weight and a constant of 6 cc/kg, due to the great restriction and the very high pressure of the airway reached, the volume intake was insignificant, which perpetuated hypoxemia. , leading to life-threatening hemodynamic instability. To avoid a fatal outcome, given the impossibility of ventilation, even with a manual device, and waiting for the start of renal replacement therapy, to eliminate the excess circulating volume, it became necessary to insert an esophageal catheter, to carry out the programming of ventilatory parameters with an adequate measurement of the alveolar opening pressure, for PEEP titration and a tidal volume value that would avoid overdistention and possible barotrauma. Once intra- and extravascular fluid removal was performed, mechanical ventilation could be returned to conventional parameters and continued until successful release of support.