TY - JOUR
T1 - The application of esophageal pressure measurement in patients with respiratory failure
AU - Akoumianaki, Evangelia
AU - Maggiore, Salvatore M.
AU - Valenza, Franco
AU - Bellani, Giacomo
AU - Jubran, Amal
AU - Loring, Stephen H.
AU - Pelosi, Paolo
AU - Talmor, Daniel
AU - Grasso, Salvatore
AU - Chiumello, Davide
AU - Gué Rin, Claude
AU - Patroniti, Nicolo
AU - Ranieri, V. Marco
AU - Gattinoni, Luciano
AU - Nava, Stefano
AU - Terragni, Pietro Paolo
AU - Pesenti, Antonio
AU - Tobin, Martin
AU - Mancebo, Jordi
AU - Brochard, Laurent
PY - 2014/3/1
Y1 - 2014/3/1
N2 - This report summarizes current physiological and technical knowledge on esophageal pressure (Pes) measurements in patients receiving mechanical ventilation.The respiratory changes in Pes are representative of changes in pleural pressure. The difference between airway pressure (Paw) and Pes is a valid estimate of transpulmonary pressure. Pes helps determine what fraction of Paw is applied to overcome lung and chest wall elastance. Pes is usually measured via a catheter with an airfilled thin-walled latex balloon inserted nasally or orally. To validate Pesmeasurement, a dynamic occlusion testmeasures the ratio of change in Pes to change inPawduring inspiratory efforts against a closed airway. A ratio close to unity indicates that the system provides a valid measurement. Provided transpulmonary pressure is the lung-distending pressure, and that chest wall elastance may vary among individuals, a physiologically based ventilator strategy should take the transpulmonary pressure into account. For monitoring purposes, clinicians rely mostly on Paw and flow waveforms. However, these measurements may mask profound patient-ventilator asynchrony and do not allow respiratory muscle effort assessment. Pes also permits the measurement of transmural vascular pressures during both passive and active breathing. Pes measurements have enhanced our understanding of the pathophysiology of acute lung injury, patient-ventilator interaction, and weaning failure. The use of Pes for positive end-expiratory pressure titrationmay help improve oxygenation and compliance. Pes measurements make it feasible to individualize the level of muscle effort during mechanical ventilation and weaning. The time is now right to apply the knowledge obtained with Pes to improve the management of critically ill and ventilator-dependent patients.
AB - This report summarizes current physiological and technical knowledge on esophageal pressure (Pes) measurements in patients receiving mechanical ventilation.The respiratory changes in Pes are representative of changes in pleural pressure. The difference between airway pressure (Paw) and Pes is a valid estimate of transpulmonary pressure. Pes helps determine what fraction of Paw is applied to overcome lung and chest wall elastance. Pes is usually measured via a catheter with an airfilled thin-walled latex balloon inserted nasally or orally. To validate Pesmeasurement, a dynamic occlusion testmeasures the ratio of change in Pes to change inPawduring inspiratory efforts against a closed airway. A ratio close to unity indicates that the system provides a valid measurement. Provided transpulmonary pressure is the lung-distending pressure, and that chest wall elastance may vary among individuals, a physiologically based ventilator strategy should take the transpulmonary pressure into account. For monitoring purposes, clinicians rely mostly on Paw and flow waveforms. However, these measurements may mask profound patient-ventilator asynchrony and do not allow respiratory muscle effort assessment. Pes also permits the measurement of transmural vascular pressures during both passive and active breathing. Pes measurements have enhanced our understanding of the pathophysiology of acute lung injury, patient-ventilator interaction, and weaning failure. The use of Pes for positive end-expiratory pressure titrationmay help improve oxygenation and compliance. Pes measurements make it feasible to individualize the level of muscle effort during mechanical ventilation and weaning. The time is now right to apply the knowledge obtained with Pes to improve the management of critically ill and ventilator-dependent patients.
KW - Mechanical ventilation
KW - Pleural pressure
KW - Respiratory mechanics
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U2 - 10.1164/rccm.201312-2193CI
DO - 10.1164/rccm.201312-2193CI
M3 - Article
C2 - 24467647
AN - SCOPUS:84895517286
VL - 189
SP - 520
EP - 531
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
SN - 1073-449X
IS - 5
ER -