TY - JOUR
T1 - Esophageal balloon calibration during Sigh
T2 - A physiologic, randomized, cross-over study
AU - Cammarota, Gianmaria
AU - Santangelo, Erminio
AU - Lauro, Gianluigi
AU - Verdina, Federico
AU - Boniolo, Ester
AU - De Vita, Nello
AU - Tarquini, Riccardo
AU - Spinelli, Elena
AU - Garofalo, Eugenio
AU - Bruni, Andrea
AU - Zanoni, Marta
AU - Messina, Antonio
AU - Pesenti, Antonio
AU - Corte, Francesco Della
AU - Navalesi, Paolo
AU - Vaschetto, Rosanna
AU - Mauri, Tommaso
N1 - Funding Information:
The investigation was financially supported with institutional funding.
Funding Information:
Prof. Paolo Navalesi reports grants, personal fees and non-financial support from Maquet Critical Care, grants and non-financial support from Draeger, grants and non-financial support from Intersurgical S.p.A, personal fees from Oriopharma, personal fees from Philips, personal fees from Resmed, personal fees from MSD, personal fees from Novartis, outside the submitted work. In addition, Prof. Navalesi has a patent helmet Next with royalties paid to Intersurgical Spa, and a patent EP20170199831 pending.
Funding Information:
The authors wish to thank all the staff of the intensive care unit for their contributions to conduct the present study. This research was supported by Azienda Ospedaliero-Universitaria Maggiore della Carità , Novara, Italy.
Publisher Copyright:
© 2020 Elsevier Inc.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - Purpose: Optimal esophageal balloon filling volume (Vbest) depends on the intrathoracic pressure. During Sigh breath delivered by the ventilator machine, esophageal balloon is surrounded by elevated intrathoracic pressure that might require higher filling volume for accurate measure of tidal changes in esophageal pressure (Pes). The primary aim of our investigation was to evaluate and compare Vbest during volume controlled and pressure support breaths vs. Sigh breath. Materials and methods: Twenty adult patients requiring invasive volume-controlled ventilation (VCV) for hypoxemic acute respiratory failure were enrolled. After the insertion of a naso-gastric catheter equipped with 10 ml esophageal balloon, each patient underwent three 30-min trials as follows: VCV, pressure support ventilation (PSV), and PSV + Sigh. Sigh was added to PSV as 35 cmH2O pressure-controlled breath over 4 s, once per minute. PSV and PSV + Sigh were randomly applied and, at the end of each step, esophageal balloon calibration was performed. Results: Vbest was higher for Sigh breath (4.5 [3.0–6.8] ml) compared to VCV (1.5 [1.0–2.9] ml, P = 0.0004) and PSV tidal breath (1.0 [0.5–2.4] ml, P < 0.0001). Conclusions: During Sigh breath, applying a calibrated approach for Pes assessment, a higher Vbest was required compared to VCV and PSV tidal breath.
AB - Purpose: Optimal esophageal balloon filling volume (Vbest) depends on the intrathoracic pressure. During Sigh breath delivered by the ventilator machine, esophageal balloon is surrounded by elevated intrathoracic pressure that might require higher filling volume for accurate measure of tidal changes in esophageal pressure (Pes). The primary aim of our investigation was to evaluate and compare Vbest during volume controlled and pressure support breaths vs. Sigh breath. Materials and methods: Twenty adult patients requiring invasive volume-controlled ventilation (VCV) for hypoxemic acute respiratory failure were enrolled. After the insertion of a naso-gastric catheter equipped with 10 ml esophageal balloon, each patient underwent three 30-min trials as follows: VCV, pressure support ventilation (PSV), and PSV + Sigh. Sigh was added to PSV as 35 cmH2O pressure-controlled breath over 4 s, once per minute. PSV and PSV + Sigh were randomly applied and, at the end of each step, esophageal balloon calibration was performed. Results: Vbest was higher for Sigh breath (4.5 [3.0–6.8] ml) compared to VCV (1.5 [1.0–2.9] ml, P = 0.0004) and PSV tidal breath (1.0 [0.5–2.4] ml, P < 0.0001). Conclusions: During Sigh breath, applying a calibrated approach for Pes assessment, a higher Vbest was required compared to VCV and PSV tidal breath.
KW - Artefacts
KW - Artificial respiration
KW - Manometry
KW - Respiratory mechanics
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U2 - 10.1016/j.jcrc.2020.10.021
DO - 10.1016/j.jcrc.2020.10.021
M3 - Article
C2 - 33157308
AN - SCOPUS:85095742126
VL - 61
SP - 125
EP - 132
JO - Journal of Critical Care
JF - Journal of Critical Care
SN - 0883-9441
ER -