Síguenos en Twitter     Síguenos en Facebook     Síguenos en YouTube     Siguenos en Linkedin     Correo Grupsagessa     Gmail     Yahoo Mail     Dropbox     Instagram     Slack     Google Drive     Print     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon


Mi foto
FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com


iEM Education Project in 12 Questions (https://iem-student.org/)

Buscar en contenido


miércoles, 24 de febrero de 2016

PEEP in the Morbidly Obese

Resultado de imagen de Pulm CCM
PulmCCM - February 17, 2016 - By Jon-Emile Kenny
A recent study of applied respiratory physiology in the mechanically-ventilated, obese patient was published. The ubiquitous focus on lung protective ventilation with “low” [physiological] lung volumes, and low plateau pressure may leave the obese patient susceptible to untoward respiratory embarrassment. Excess abdominal and chest wall weight affect each of the following: reduction in lung volume, increased expiratory flow limitation, increased gas-trapping andaugmentation of auto-PEEP. Cephalad displacement of the diaphragm from increased intra-abdominal pressure may explain why obese patients have been found to have a negative transpulmonary pressure [Ptp = alveolar pressure minus pleural pressure]. Note that a negative Ptp designates a pleural pressure greater than alveolar pressure which suggests lung volume loss [collapse]. Because the pressure within the alveolus at end-expiration [or inspiration for that matter] reflects the elastance of both the lungs, and chest wall, it is possible that PEEP – in the obese – is ‘under-dosed.’