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Intensive Care Medicine

, Volume 29, Issue 6, pp 955–962 | Cite as

Alveolar pressure monitoring: an evaluation in a lung model and in patients with acute lung injury

  • S. SondergaardEmail author
  • S. Kárason
  • J. Wiklund
  • S. Lundin
  • O. Stenqvist
Original

Abstract

Objectives

We evaluated an algorithm for continuous on-line monitoring of alveolar pressure over time in a lung model with lower and upper inflection points and variable resistance ratios and in patients with acute lung injury. The algorithm is based on "static" pressure/volume curves obtained from tracheal pressure measurements under dynamic conditions.

Design and setting

Experimental and clinical evaluation of algorithm in a university hospital laboratory and intensive care unit.

Patients

Ten patients undergoing postoperative respiratory therapy (feasibility of tracheal measurement) and ten patients with acute lung injury undergoing ventilator treatment (evaluation of algorithm).

Measurements and results

Direct tracheal pressure measurements with a catheter inserted through the endotracheal tube. Comparison of measured alveolar and the dynostatic alveolar pressure vs. time in a lung model with changes in five ventilatory parameters. Examples of clinical monitoring are reported. In the model there was excellent agreement between alveolar pressures obtained by the algorithm, the dynostatic alveolar pressure, and measured alveolar pressure at all ventilator settings. For inspiratory/expiratory resistance ratios between 1:2.1–2.1:1, the dynostatic alveolar pressure was within ±1.5 cm H2O of measured alveolar pressure. In patients the technique for direct tracheal pressure measurement using a catheter inserted through the endotracheal tube functioned satisfactorily with intermittent air flushes for cleansing.

Conclusions

Using a thin tracheal pressure catheter inserted through the endotracheal tube alveolar pressure allows continuous bedside monitoring with ease and precision using the dynostatic algorithm. The method is unaffected by tube and connector geometry or by secretions.

Keywords

Respiratory mechanics Alveolar pressure Dynostatic algorithm 

Notes

Acknowledgements

The Göteborg Medical Society, AGA Medical Research Fund, and the Medical Faculty of Göteborg University supported this study.

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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • S. Sondergaard
    • 1
    Email author
  • S. Kárason
    • 2
  • J. Wiklund
    • 3
  • S. Lundin
    • 1
  • O. Stenqvist
    • 1
  1. 1.Department of Anaesthesia and Intensive CareSahlgrenska University HospitalGothenburgSweden
  2. 2.Department of Anaesthesia and Intensive CareLandspitali University HospitalReykjavikIceland
  3. 3.Department of Biomedical EngineeringSahlgrenska University HospitalGothenburgSweden

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