Terapia ventilatoria guiada con catéter esofágico en una cohorte de SDRA asociado a covid en pacientes con obesidad

Abstract

Introduction

The management of acute respiratory distress syndrome (ARDS) has evolved with the adoption of lung-protective strategies. However, accurate PEEP titration remains a challenge, particularly in patients with obesity. Measuring transpulmonary pressure through an esophageal catheter allows for a more individualized and objective PEEP adjustment. The aim of this study was to describe the clinical and ventilatory characteristics of a cohort of obese patients with covid-19-associated ARDS managed with mechanical ventilation guided by an esophageal catheter.

Materials and methods

A retrospective observational cohort study was conducted at a tertiary care ICU in Medellín (Colombia) during the SARS-CoV-2 pandemic. Patients included had a diagnosis of ARDS based on the Berlin criteria, a body mass index (BMI) greater than 30, required invasive mechanical ventilation, and received esophageal catheter placement to guide PEEP titration. Patients without confirmed ARDS or who did not require the catheter were excluded. A univariate analysis of clinical, ventilatory, and outcome variables was performed.

Results

Eleven patients with severe ARDS and obesity (mean BMI 34.2) were analyzed. The average PEEP was 15.5 cm H₂O, with sustained positive expiratory transpulmonary pressures. Mortality was 36.4%, lower than previously reported in similar series. All patients required neuromuscular blockade and prone positioning.

Conclusion

This study shows that the use of an esophageal catheter in obese patients with covid-19-associated ARDS may improve PEEP titration, potentially reducing mortality. Despite the limitations due to the small cohort size, these findings suggest that the esophageal catheter is a valuable tool for optimizing mechanical ventilation in patients with pulmonary alterations. Further studies with larger sample sizes are recommended to confirm these results and to explore the impact of this technique more thoroughly in clinical practice.