• Guramrinder Singh Thind, Eduardo Mireles-Cabodevila, Robert L Chatburn, and Abhijit Duggal.
• Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio. thindg@ccf.org.
• Respir Care. 2022 Feb 1; 67 (2): 184190184-190.

BackgroundPatients who are obese are at risk for developing high pleural pressure, which leads to alveolar collapse. Esophageal pressure (Pes) can be used as a surrogate for pleural pressure and can be used to guide PEEP titration. Although recent clinical data on Pes-guided PEEP has shown no benefit, its utility in the subgroup of patients who are obese has not been studied.MethodsThe Medical Information Mart for Intensive Care-III critical care database was queried to gather data on Pes in subjects on mechanical ventilation. Pes in obese and non-obese groups were compared, and a subgroup analysis was performed in subjects with class III obesity. Thereafter, empirical and Pes-guided PEEP protocols of a recently published trial were theoretically applied to the obese group and ventilator outcomes were compared.ResultsA total of 105 subjects were included in the study. The average end-expiratory Pes in the obese group was 18.8 ± 5 cm H2O compared with 16.8 ± 4.8 cm H2O in the non-obese group (P < .05). If Pes-guided PEEP protocol was to be applied to those in the obese group, then the PEEP setting would be significantly higher than empirical PEEP setting. These findings were accentuated in the subgroup of subjects with class III obesity.ConclusionsIndividualization of PEEP with Pes guidance may have a role in patients who are obese.Copyright © 2022 by Daedalus Enterprises.

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