AUTHOR=Wang Qianling , Su Longxiang , Jiang Jing , Wang Na , He Huaiwu , Long Yun 

TITLE=Incorporating electrical impedance tomography to transpulmonary pressure-guided PEEP in severe ARDS with pneumothorax and multiple cavitations: a case report

JOURNAL=Frontiers in Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1240321

DOI=10.3389/fmed.2023.1240321

ISSN=2296-858X

ABSTRACT=<p>Pneumothorax is a potentially fatal complication in patients with acute respiratory distress syndrome (ARDS), presenting challenges in determining the optimal positive end-expiratory pressure (PEEP) level to prevent atelectasis without exacerbating the pneumothorax. This case report describes the successful application of transpulmonary pressure and electrical impedance tomography (EIT) at the bedside to guide PEEP selection in a patient with ARDS complicated by pneumothorax due to methicillin-resistant <italic>Staphylococcus aureus</italic> infection. By using minimal PEEP to maintain positive end-expiratory transpulmonary pressure and visualizing lung reopening with EIT, the optimal PEEP level was reaffirmed, even if traditionally considered high. The patient’s condition improved, and successful weaning from the ventilator was achieved, leading to a transfer out of the intensive care unit.</p><p><bold>Clinical trial registration</bold>: <ext-link xlink:href="https://clinicaltrials.gov/show/NCT04081142" ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink">https://clinicaltrials.gov/show/NCT04081142</ext-link>, identifier NCT04081142.</p>