The application of esophageal pressure measurement in patients with respiratory failure

Evangelia Akoumianaki, Salvatore M. Maggiore, Franco Valenza, Giacomo Bellani, Amal Jubran, Stephen H. Loring, Paolo Pelosi, Daniel Talmor, Salvatore Grasso, Davide Chiumello, Claude Gué Rin, Nicolo Patroniti, V. Marco Ranieri, Luciano Gattinoni, Stefano Nava, Pietro Paolo Terragni, Antonio Pesenti, Martin Tobin, Jordi Mancebo, Laurent Brochard

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)520-531
Number of pages12
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume189
Issue number5
DOIs
Publication statusPublished - Mar 1 2014

Keywords

  • Mechanical ventilation
  • Pleural pressure
  • Respiratory mechanics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'The application of esophageal pressure measurement in patients with respiratory failure'. Together they form a unique fingerprint.

  • Cite this

    Akoumianaki, E., Maggiore, S. M., Valenza, F., Bellani, G., Jubran, A., Loring, S. H., Pelosi, P., Talmor, D., Grasso, S., Chiumello, D., Gué Rin, C., Patroniti, N., Ranieri, V. M., Gattinoni, L., Nava, S., Terragni, P. P., Pesenti, A., Tobin, M., Mancebo, J., & Brochard, L. (2014). The application of esophageal pressure measurement in patients with respiratory failure. American Journal of Respiratory and Critical Care Medicine, 189(5), 520-531. https://doi.org/10.1164/rccm.201312-2193CI