# High PEEP extubation as guided by esophageal manometry

## TL;DR

This paper discusses using esophageal manometry to guide high PEEP settings during extubation in a morbidly obese patient with respiratory failure.

## Contribution

The paper demonstrates the successful use of esophageal manometry-guided PEEP titration for extubation in a morbidly obese patient.

## Key findings

- Esophageal manometry-guided PEEP improved oxygenation in a morbidly obese patient.
- High PEEP settings allowed successful extubation after spontaneous breathing trials.
- The approach was effective during two ICU admissions for respiratory failure.

## Abstract

The ventilatory management of morbidly obese patients presents an ongoing challenge in the Intensive Care Unit (ICU) as multiple physiologic changes in the respiratory system complicate weaning efforts and make extubation more difficult, often leading to increased time on the ventilator. We report the case of a young adult male who presented to our ICU on two separate occasions with hypoxemic respiratory failure requiring intubation. Esophageal manometry (EM) guided positive end expiratory pressure (PEEP) titration was utilized during both ICU admissions to improve oxygenation and aid in extubation with spontaneous breathing trials performed on higher-than-normal PEEP settings and successful liberation on both occasions.