The assessment of transpulmonary pressure in mechanically ventilated ARDS patients

Davide Chiumello, Massimo Cressoni, Andrea Colombo, Giovanni Babini, Matteo Brioni, Francesco Crimella, Stefan Lundin, Ola Stenqvist, Luciano Gattinoni

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The optimal method for estimating transpulmonary pressure (i.e. the fraction of the airway pressure transmitted to the lung) has not yet been established.

Methods: In this study on 44 patients with acute respiratory distress syndrome (ARDS), we computed the end-inspiratory transpulmonary pressure as the change in airway and esophageal pressure from end-inspiration to atmospheric pressure (i.e. release derived) and as the product of the end-inspiratory airway pressure and the ratio of lung to respiratory system elastance (i.e. elastance derived). The end-expiratory transpulmonary pressure was estimated as the product of positive end-expiratory pressure (PEEP) minus the direct measurement of esophageal pressure and by the release method.

Results: The mean elastance- and release-derived transpulmonary pressure were 14.4 ± 3.7 and 14.4 ± 3.8 cmH2O at 5 cmH2O of PEEP and 21.8 ± 5.1 and 21.8 ± 4.9 cmH2O at 15 cmH2O of PEEP, respectively (P = 0.32, P = 0.98, respectively), indicating that these parameters were significantly related (r2 = 0.98, P <0.001 at 5 cmH2O of PEEP; r2 = 0.93, P <0.001 at 15 cmH2O of PEEP). The percentage error was 5.6 and 12.0 %, respectively. The mean directly measured and release-derived transpulmonary pressure were −8.0 ± 3.8 and 3.9 ± 0.9 cmH2O at 5 cmH2O of PEEP and −1.2 ± 3.2 and 10.6 ± 2.2 cmH2O at 15 cmH2O of PEEP, respectively, indicating that these parameters were not related (r2 = 0.07, P = 0.08 at 5 cmH2O of PEEP; r2 = 0.10, P = 0.53 at 15 cmH2O of PEEP).

Conclusions: Based on our observations, elastance-derived transpulmonary pressure can be considered to be an adequate surrogate of the release-derived transpulmonary pressure, while the release-derived and directly measured end-expiratory transpulmonary pressure are not related.

Original languageEnglish
Pages (from-to)1670-1678
Number of pages9
JournalIntensive Care Medicine
Volume40
Issue number11
DOIs
Publication statusPublished - Oct 15 2014

Keywords

  • Acute respiratory distress syndrome
  • Computed tomography
  • Esophageal pressure
  • PEEP
  • Transpulmonary pressure

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

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