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Related Experiment Video

Updated: Jun 5, 2026

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

Published on: December 14, 2020

Optimal PEEP guided by esophageal balloon manometry.

Tom Piraino¹, Deborah J Cook

¹Critical Care Services, St Joseph's Healthcare, Hamilton, Ontario, Canada. tpiraino@stjoes.ca

Respiratory Care

|January 25, 2011

Summary

Severe ascites and septic shock caused difficult ventilation. High PEEP guided by esophageal pressure improved oxygenation, enabling successful mechanical ventilation weaning.

Area of Science:

Critical Care Medicine
Respiratory Physiology
Nephrology

Background:

A 45-year-old female presented with severe ascites and septic shock secondary to an obstructive ureteric stone.
The patient experienced refractory hypoxemia despite maximal ventilator support, including high fraction of inspired oxygen (FIO2) and positive end-expiratory pressure (PEEP).

Observation:

Elevated intra-abdominal pressure due to severe ascites was suspected to impair lung compliance and gas exchange.
An esophageal balloon catheter was used to monitor intra-abdominal pressure and guide PEEP titration.

Findings:

PEEP was adjusted to 32 cm H2O to achieve a transpulmonary pressure of 0 cm H2O, effectively counteracting the effects of abdominal pressure on the lungs.
This intervention led to rapid and significant improvement in oxygenation within 6 hours, with PaO2/FIO2 increasing from 80 to 244 mm Hg and oxygenation index decreasing from 35 to 18.

Related Experiment Videos

Last Updated: Jun 5, 2026

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

Published on: December 14, 2020

Further improvements were noted at 48 hours (PaO2/FIO2: 382 mm Hg; oxygenation index: 7).

Paracentesis of 5 L of ascites facilitated ventilator weaning.

The patient was successfully weaned from mechanical ventilation in 10 days without complications related to the high PEEP strategy.

Implications:

Monitoring intra-abdominal pressure with esophageal manometry can guide PEEP titration in patients with severe ascites and respiratory compromise.
Optimizing PEEP based on transpulmonary pressure may improve oxygenation and facilitate ventilator liberation in challenging critical care scenarios.
This case highlights a potential strategy for managing severe abdominal hypertension impacting respiratory mechanics.