Article Text

Download PDFPDF
Case report
Oesophageal pressure-guided management of severe acute respiratory distress syndrome in a patient with intractable intracranial hypertension
  1. Danny Theodore1,
  2. Dea Mahanes2 and
  3. Michael Leite3
  1. 1 Anesthesiology and Critical Care Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
  2. 2 Nerancy Neuro Intensive Care Unit, University of Virginia Health System, Charlottesville, Virginia, USA
  3. 3 Department of Pulmonary Diagnostics and Respiratory Therapy, University of Virginia Health System, Charlottesville, Virginia, USA
  1. Correspondence to Dr Danny Theodore; dt7sj{at}


We present a case of a young boy who sustained a traumatic brain injury (TBI) complicated by intractable intracranial hypertension and severe acute respiratory distress syndrome (ARDS) with hypercapnia. The coexisting pulmonary pathology significantly impacted intracranial pressure management. Oesophageal pressure manometry was used to guide ventilator and airway pressure management, allowing the team to optimise ARDS care while mitigating the risk of elevated intracranial pressure. While the literature describing the use of oesophageal pressure-guided ARDS management continues to evolve, there are no reported cases demonstrating use in patients with ARDS and intractable intracranial hypertension due to TBI.

  • adult intensive care
  • mechanical ventilation
  • neurology
  • coma and raised intracranial pressure
  • trauma CNS /PNS

Statistics from


  • Contributors All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing or revision of the manuscript. DT collected clinical data and images and contributed to the background and discussion. DM collected the clinical data and contributed to the summary and discussion. She also reviewed and edited the article. ML collected the ventilator and oesophageal catheter data and helped with interpretation of the data. He contributed the background and literature review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.