Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives
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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.
This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes.
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.
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.
KeywordsEsophageal pressure Acute respiratory failure Acute respiratory distress syndrome Physiologic monitoring Mechanical ventilation
The PLeUral pressure working Group (PLUG) is part of the Acute Respiratory Failure Section of the European Society of Intensive Care Medicine (ESICM). The aims and members of the PLUG Working Group are listed in the ESM. We would like to thank all the members of the PLUG Working Group for their active participation. We also thank Mr. Guy François and the European Society of Intensive Care Medicine (ESICM) for their continuous support to the activities of the PLUG Working Group.
Compliance with ethical standards
E. Goligher is supported by a Post-Doctoral Fellowship from the Canadian Institutes of Health Research and by ISCIII PI13/02204-FEDER, CIBER Enfermedades Respiratorias to L. Blanch; T. Yoshida is funded by a RESTRACOMP training award from the Research Institute of the Hospital for Sick Children, Toronto, ON, Canada. L. Brochard is the Keenan Chair in Critical Care and Acute Respiratory failure, Keenan Research Centre, Toronto.
Conflicts of interest
F. Mojoli, D. Chiumello and L. Gattinoni were involved in a University research spin-off for the development of Nutrivent [Sidam, Mirandola (MO), Italy]. L. Blanch is inventor of one Corporació Sanitaria Parc Taulí-owned U.S. patent (US Patent No. 12/538,940): “Method and system for managed related patient parameters provided by a monitoring device”. L. Blanch owns stock options of BetterCare S.L., which is a research and development spin off of Corporació Sanitària Parc Taulí (Spain). Outside the submitted work, J. Mancebo reports grants from Covidien, non-financial support from Maquet and General Electric and personal fees from Covidien, Hamilton, Braun, Air-Liquide, Faron, and A-Lung. Outside the submitted work, L. Brochard reports grants from Covidien, Fisher Paykel, non-financial support from Maquet, Philips and General Electric and personal fees from Covidien and Maquet. All other authors declare that they do not have any conflicts of interest to declare.
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