No abstract

Patient:A 32-year-old man with severe obesity and a BMI of 51.7 was hospitalized because of pneumonia. He underwent respiratory management with a mechanical ventilator; however, because the respiratory management was difficult (P/F ratio was around 50), he was transferred to the ICU. Transpulmonary pressure was monitored, and in order to address the decreased thoracic compliance and pressure on the diaphragm due to severe obesity, we conducted respiratory management with high PEEP, which resulted in an improvement in the respiratory condition. Furthermore, when we conducted continuous negative abdominal pressure management to improve the pressure on the diaphragm, the end-expiratory transpulmonary pressure was elevated under the same respiratory condition. Discussion: Avoiding lung injury related to the use of a mechanical ventilator is important during the management of respiratory failure, and lung-protective ventilation and the open lung approach are the primary strategies adopted for this purpose. Because of the high abdominal pressure in patients with severe obesity, alveolar collapse is enhanced by the decrease in transpulmonary pressure due to the pressure on the diaphragm. In the present patient, abdominal pressure was decreased because of continuous negative abdominal pressure management, and an elevation of end-expiratory transpulmonary pressure was observed under the same respiratory condition. We believe that the obtained change can improve atelectasis, thereby benefiting the open lung.