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Intensive Care Med. 2016 Sep;42(9):1360-73. doi: 10.1007/s00134-016-4400-x. Epub 2016 Jun 22.

Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives.

Author information

1
Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
2
Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
3
Intensive Care Unit, Osaka University Hospital, Suita, Japan.
4
Department of Anesthesia, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
5
Department of Health Science, University of Milan-Bicocca, Monza, MB, Italy.
6
Department of Physiology, University of Toronto, Toronto, Canada.
7
Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.
8
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
9
DHU A-TVB, Service de Réanimation Médicale, CHU Henri Mondor, Assistance Publique-Hôpitaux de Paris, , Créteil, France.
10
Groupe de recherche clinique CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, Créteil, France.
11
Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand.
12
Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
13
Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
14
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
15
Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland.
16
Department of Medical Intensive Care, University Hospital of Angers, Angers, France.
17
Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari "Aldo Moro", Bari, Italy.
18
Division of Pulmonary and Critical Care Medicine, Edward Hines Jr., Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL, USA.
19
Department of Critical Care, McGill University Heath Centre, Glen Site Campus, Montreal, QC, Canada.
20
Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
21
Institut de Investigació i Innovació Parc Taulí, CIBER Enfermedades Respiratorias, Critical Care Center, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain.
22
Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
23
Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. BrochardL@smh.ca.
24
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. BrochardL@smh.ca.
25
Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain.

Abstract

PURPOSE:

Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only.

METHODS:

This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes.

RESULTS:

After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning. Moreover, Pes monitoring permits accurate measurement of transmural vascular pressure and intrinsic positive end-expiratory pressure and facilitates detection of patient-ventilator asynchrony, thereby supporting specific diagnoses and interventions. Finally, some Pes-derived measures may also be obtained by monitoring electrical activity of the diaphragm.

CONCLUSIONS:

Pes monitoring provides unique bedside measures for a better understanding of the pathophysiology of acute respiratory failure patients. Including Pes monitoring in the intensivist's clinical armamentarium may enhance treatment to improve clinical outcomes.

KEYWORDS:

Acute respiratory distress syndrome; Acute respiratory failure; Esophageal pressure; Mechanical ventilation; Physiologic monitoring

PMID:
27334266
DOI:
10.1007/s00134-016-4400-x
[Indexed for MEDLINE]

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