Intensive Care Medicine

, Volume 42, Issue 9, pp 1360–1373 | Cite as

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

  • Tommaso Mauri
  • Takeshi Yoshida
  • Giacomo Bellani
  • Ewan C. Goligher
  • Guillaume Carteaux
  • Nuttapol Rittayamai
  • Francesco Mojoli
  • Davide Chiumello
  • Lise Piquilloud
  • Salvatore Grasso
  • Amal Jubran
  • Franco Laghi
  • Sheldon Magder
  • Antonio Pesenti
  • Stephen Loring
  • Luciano Gattinoni
  • Daniel Talmor
  • Lluis Blanch
  • Marcelo Amato
  • Lu Chen
  • Laurent BrochardEmail author
  • Jordi Mancebo
  • the PLeUral pressure working Group (PLUG—Acute Respiratory Failure section of the European Society of Intensive Care Medicine)



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.


Esophageal 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.

Supplementary material

134_2016_4400_MOESM1_ESM.docx (865 kb)
Supplementary material 1 (DOCX 865 kb)

Supplementary material 2 (MP4 277228 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Tommaso Mauri
    • 1
  • Takeshi Yoshida
    • 2
    • 3
    • 4
  • Giacomo Bellani
    • 5
  • Ewan C. Goligher
    • 6
    • 7
    • 12
  • Guillaume Carteaux
    • 8
    • 9
  • Nuttapol Rittayamai
    • 10
    • 11
    • 12
  • Francesco Mojoli
    • 13
  • Davide Chiumello
    • 1
    • 14
  • Lise Piquilloud
    • 15
    • 16
  • Salvatore Grasso
    • 17
  • Amal Jubran
    • 18
  • Franco Laghi
    • 18
  • Sheldon Magder
    • 19
  • Antonio Pesenti
    • 1
    • 14
  • Stephen Loring
    • 20
  • Luciano Gattinoni
    • 1
    • 14
  • Daniel Talmor
    • 20
  • Lluis Blanch
    • 21
  • Marcelo Amato
    • 22
  • Lu Chen
    • 11
    • 12
  • Laurent Brochard
    • 11
    • 12
    Email author
  • Jordi Mancebo
    • 23
  • the PLeUral pressure working Group (PLUG—Acute Respiratory Failure section of the European Society of Intensive Care Medicine)
  1. 1.Department of Anesthesia, Critical Care and EmergencyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Department of Critical Care Medicine, Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  3. 3.Intensive Care UnitOsaka University HospitalSuitaJapan
  4. 4.Department of Anesthesia, Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  5. 5.Department of Health ScienceUniversity of Milan-BicoccaMonzaItaly
  6. 6.Department of PhysiologyUniversity of TorontoTorontoCanada
  7. 7.Division of Respirology, Department of MedicineUniversity Health Network and Mount Sinai HospitalTorontoCanada
  8. 8. DHU A-TVB, Service de Réanimation Médicale, CHU Henri MondorAssistance Publique-Hôpitaux de Paris, CréteilFrance
  9. 9.Groupe de recherche clinique CARMAS, Faculté de Médecine de CréteilUniversité Paris Est CréteilCréteilFrance
  10. 10.Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of MedicineSiriraj HospitalBangkokThailand
  11. 11.Keenan Research Centre, Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  12. 12.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  13. 13.Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
  14. 14.Dipartimento di Fisiopatologia Medico-Chirurgica e dei TrapiantiUniversità degli Studi di MilanoMilanItaly
  15. 15.Adult Intensive Care and Burn UnitUniversity Hospital of LausanneLausanneSwitzerland
  16. 16.Department of Medical Intensive CareUniversity Hospital of AngersAngersFrance
  17. 17.Dipartimento dell’Emergenza e Trapianti d’Organo (DETO), Sezione di Anestesiologia e RianimazioneUniversità degli Studi di Bari “Aldo Moro”BariItaly
  18. 18.Division of Pulmonary and Critical Care MedicineEdward Hines Jr., Veterans Affairs Hospital and Loyola University of Chicago Stritch School of MedicineHinesUSA
  19. 19.Department of Critical CareMcGill University Heath CentreMontrealCanada
  20. 20.Department of Anesthesia, Critical Care, and Pain MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA
  21. 21.Institut de Investigació i Innovació Parc Taulí, CIBER Enfermedades Respiratorias, Critical Care Center, Parc Tauli Hospital UniversitariUniversitat Autònoma de BarcelonaSabadellSpain
  22. 22.Pulmonary Division, Heart Institute (InCor), Hospital das ClínicasUniversity of São PauloSão PauloBrazil
  23. 23.Servei de Medicina IntensivaHospital de Sant PauBarcelonaSpain

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