To investigate the clinical effect of positive end-expiratory pressure guided by esophageal pressure on postoperative hypoxemia patients with acute Stanford A aortic dissection.

From January 2016 to February 2017, 40 patients with hypoxemia after acute Stanford A aortic dissection in Nanjing Hospital Affiliated to Nanjing Medical University were divided into the esophageal pressure monitoring group and routine treatment group, 20 cases in each group. The general data and prognosis of patients in the two groups were recorded. The indexes of gas exchange and respiratory mechanics including positive end-expiratory pressure, oxygenation index, end-expiratory transpulmonary pressure, end-inspiratory transpulmonary pressure, pulmonary driving pressure, pulmonary elastic resistance, chest wall driving pressure, chest wall elastic resistance, respiratory system drive pressure and respiratory system elastic resistance were compared between the two groups.

The positive end-expiratory pressure, arterial blood oxygenation index, end-expiratory transpulmonary pressure, pulmonary driving pressure and pulmonary elastic resistance were significantly different between postoperative hypoxemia patients with acute Stanford A aortic dissection in the two groups at the admission, 24 h and 48 h after admission (F=9.583, 9.544, 17.806, 4.799, 6.830; P=0.004, 0.004, < 0.001, 0.035, 0.013). Further comparison showed that the positive end-expiratory pressure, arterial blood oxygenation index and end-expiratory transpulmonary pressure were significantly higher in the esophageal pressure monitoring group than in the routine treatment group at 24 h and 48 h after admission respectively (all P < 0.05), while the pulmonary driving pressure and pulmonary elastic resistance were significantly lower (all P < 0.05). Compared with the routine treatment group, the mechanical ventilation time in the esophageal pressure monitoring group significantly decreased [(68 ± 20) h vs. (55 ± 16) h; t=2.261, P=0.030]. However, there were no significant differences in the length of stay in ICU [(101 ± 26) h vs. (92 ± 24) h; t=1.226, P=0.228] and 28 d mortality (10% vs. 0.5%, t=0.360, P=0.548) between the two groups.

Adjusting positive end-expiratory pressure according to esophageal pressure monitoring can significantly improve the oxygenation index, reduce the pulmonary driving pressure and pulmonary elastic resistance, and shorten the mechanical ventilation time of patients with hypoxemia after acute Stanford A aortic dissection.