Liquid-filled esophageal catheter for measuring pleural pressure in preterm neonates

1989 ◽  
Vol 67 (2) ◽  
pp. 889-893 ◽  
Author(s):  
A. L. Coates ◽  
G. M. Davis ◽  
P. Vallinis ◽  
E. W. Outerbridge
Keyword(s):  
Chest Wall ◽  
Precise Measurement ◽  
Esophageal Pressure ◽  
Lung Mechanics ◽  
Pleural Pressure ◽  
Preterm Neonates ◽  
Alveolar Pressure ◽  
Occlusion Test ◽  
Catheter System ◽  
Airway Opening

The precise measurement of esophageal pressure (Pes) as a reflection of pleural pressure (Ppl) is crucial to the measurement of lung mechanics in the newborn. The fidelity of Pes as a measurement of Ppl is determined by the occlusion test in which, during respiratory efforts against an occlusion at the airway opening, changes in pressure (delta Pao) (Pao is assumed to be equal to alveolar pressure) are shown to be equal to changes in Pes (delta Pes). Eight intubated premature infants (640–3,700 g) with chest wall distortion were studied using a water-filled catheter system to measure Pes. During the occlusion test, all patients had a finite region of the esophagus where delta Pes equaled delta Pao, which corresponded to points in the esophagus above the cardia but below the carina. In conclusion, even in the presence of chest wall distortion, a liquid-filled catheter with the tip between the cardia and carina can provide an accurate measurement of Ppl, even in the very small premature infant with chest wall distortion.

Measurement of pleural pressure at low and high frequencies in normal rabbits

1987 ◽  
Vol 63 (3) ◽  
pp. 1142-1146 ◽  
Author(s):  
D. A. Chartrand ◽  
T. H. Ye ◽  
J. M. Maarek ◽  
H. K. Chang
Keyword(s):  
Body Surface ◽  
Pressure Transducer ◽  
Esophageal Pressure ◽  
Pleural Pressure ◽  
Opening Pressure ◽  
High Frequencies ◽  
Occlusion Test ◽  
Airway Opening ◽  
Catheter Tip ◽  
The Relationship

In eight tracheotomized adult rabbits placed in the supine position, we employed a catheter-tip piezoresistive pressure transducer to measure esophageal pressure (Pes) and assessed the validity of taking the changes in Pes to be the changes in pleural pressure (Ppl). We applied an occlusion test in which the tracheal cannula was occluded during either spontaneous inspiratory efforts or body surface oscillations ranging from 3 to 50 Hz. The relationship between Pes and airway opening pressure (Pao) was recorded. In all instances, the changes in Pes and Pao were virtually identical in both amplitude and phase. We conclude that, as evaluated by the occlusion test, a catheter-tip pressure transducer placed in the esophagus of rabbits can give adequate estimation of local pleural changes up to at least 50 Hz.

scholarly journals Airway Closure during Surgical Pneumoperitoneum in Obese Patients

2019 ◽  
Vol 131 (1) ◽  
pp. 58-73 ◽  
Author(s):  
Domenico Luca Grieco ◽  
Gian Marco Anzellotti ◽  
Andrea Russo ◽  
Filippo Bongiovanni ◽  
Barbara Costantini ◽  
...  
Keyword(s):  
Lung Volume ◽  
Respiratory Mechanics ◽  
Lung Mechanics ◽  
Control Group ◽  
Obese Patients ◽  
Airway Closure ◽  
Alveolar Pressure ◽  
Opening Pressure ◽  
Airway Opening ◽  
Pressure Controlled

AbstractEditor’s PerspectiveWhat We Already Know about This TopicWhat This Article Tells Us That Is NewBackgroundAirway closure causes lack of communication between proximal airways and alveoli, making tidal inflation start only after a critical airway opening pressure is overcome. The authors conducted a matched cohort study to report the existence of this phenomenon among obese patients undergoing general anesthesia.MethodsWithin the procedures of a clinical trial during gynecological surgery, obese patients underwent respiratory/lung mechanics and lung volume assessment both before and after pneumoperitoneum, in the supine and Trendelenburg positions, respectively. Among patients included in this study, those exhibiting airway closure were compared to a control group of subjects enrolled in the same trial and matched in 1:1 ratio according to body mass index.ResultsEleven of 50 patients (22%) showed airway closure after intubation, with a median (interquartile range) airway opening pressure of 9 cm H2O (6 to 12). With pneumoperitoneum, airway opening pressure increased up to 21 cm H2O (19 to 28) and end-expiratory lung volume remained unchanged (1,294 ml [1,154 to 1,363] vs. 1,160 ml [1,118 to 1,256], P = 0.155), because end-expiratory alveolar pressure increased consistently with airway opening pressure and counterbalanced pneumoperitoneum-induced increases in end-expiratory esophageal pressure (16 cm H2O [15 to 19] vs. 27 cm H2O [23 to 30], P = 0.005). Conversely, matched control subjects experienced a statistically significant greater reduction in end-expiratory lung volume due to pneumoperitoneum (1,113 ml [1,040 to 1,577] vs. 1,000 ml [821 to 1,061], P = 0.006). With airway closure, static/dynamic mechanics failed to measure actual lung/respiratory mechanics. When patients with airway closure underwent pressure-controlled ventilation, no tidal volume was inflated until inspiratory pressure overcame airway opening pressure.ConclusionsIn obese patients, complete airway closure is frequent during anesthesia and is worsened by Trendelenburg pneumoperitoneum, which increases airway opening pressure and alveolar pressure: besides preventing alveolar derecruitment, this yields misinterpretation of respiratory mechanics and generates a pressure threshold to inflate the lung that can reach high values, spreading concerns on the safety of pressure-controlled modes in this setting.

scholarly journals Determinants of the esophageal-pleural pressure relationship in humans

2020 ◽  
Vol 128 (1) ◽  
pp. 78-86 ◽  
Author(s):  
Iacopo Pasticci ◽  
Paolo Cadringher ◽  
Lorenzo Giosa ◽  
Michele Umbrello ◽  
Paolo Formenti ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Chest Wall ◽  
Supine Position ◽  
Body Position ◽  
Esophageal Pressure ◽  
Lateral Position ◽  
Pleural Pressure ◽  
Absolute Value ◽  
Gravitational Forces ◽  
Chest Wall Elastance

Esophageal pressure has been suggested as adequate surrogate of the pleural pressure. We investigate after lung surgery the determinants of the esophageal and intrathoracic pressures and their differences. The esophageal pressure (through esophageal balloon) and the intrathoracic/pleural pressure (through the chest tube on the surgery side) were measured after surgery in 28 patients immediately after lobectomy or wedge resection. Measurements were made in the nondependent lateral position (without or with ventilation of the operated lung) and in the supine position. In the lateral position with the nondependent lung, collapsed or ventilated, the differences between esophageal and pleural pressure amounted to 4.4 ± 1.6 and 5.1 ± 1.7 cmH2O. In the supine position, the difference amounted to 7.3 ± 2.8 cmH2O. In the supine position, the estimated compressive forces on the mediastinum were 10.5 ± 3.1 cmH2O and on the iso-gravitational pleural plane 3.2 ± 1.8 cmH2O. A simple model describing the roles of chest, lung, and pneumothorax volume matching on the pleural pressure genesis was developed; modeled pleural pressure = 1.0057 × measured pleural pressure + 0.6592 ( r2 = 0.8). Whatever the position and the ventilator settings, the esophageal pressure changed in a 1:1 ratio with the changes in pleural pressure. Consequently, chest wall elastance (Ecw) measured by intrathoracic (Ecw = ΔPpl/tidal volume) or esophageal pressure (Ecw = ΔPes/tidal volume) was identical in all the positions we tested. We conclude that esophageal and pleural pressures may be largely different depending on body position (gravitational forces) and lung-chest wall volume matching. Their changes, however, are identical. NEW & NOTEWORTHY Esophageal and pleural pressure changes occur at a 1:1 ratio, fully justifying the use of esophageal pressure to compute the chest wall elastance and the changes in pleural pressure and in lung stress. The absolute value of esophageal and pleural pressures may be largely different, depending on the body position (gravitational forces) and the lung-chest wall volume matching. Therefore, the absolute value of esophageal pressure should not be used as a surrogate of pleural pressure.

scholarly journals Effects of High-Frequency Chest Wall Oscillation on Pleural Pressure and Oscillated Flow

2008 ◽  
Vol 42 (6) ◽  
pp. 485-491 ◽  
Author(s):  
Tal Zucker ◽  
Neil M. Skjodt ◽  
Richard L. Jones
Keyword(s):  
Chest Wall ◽  
Lung Volume ◽  
Pulse Pressure ◽  
High Frequency ◽  
Esophageal Pressure ◽  
Wall Pressure ◽  
Pleural Pressure ◽  
Significant Difference ◽  
Esophageal Balloon ◽  
Wall Oscillation

Abstract The effectiveness of high-frequency chest wall oscillation (HF-CWO) is directly related to the level of oscillated flow (vosc) in the airways. We used the Vest™ system to investigate the effects of HFCWO on chest wall and pleural pressures and we correlated these pressures to the resultant vosc. We also compared the latest HFCWO device with it predecessor. Different combinations of vest inflation pressure (background pressure) and oscillation frequency were randomly applied to 10 healthy volunteers. Chest wall pressure was determined using an air-filled bag under the vest and pleural pressure was estimated using an esophageal balloon. Reverse plethysmography was used to measure vosc at the mouth and a spirometer was used to measure changes in end-expired lung volume. We found a significant correlation between chest wall and pleural pressure with approximately one-third of the chest wall pressure transmitted into the pleural space. Mean esophageal pressure remained negative at all background pressure/frequency combinations. There was a significant correlation (p<0.0001) between the esophageal pulse pressure and vosc, which was highest at 15Hz regardless of the background pressure. The end-expired lung volume correlated with mean chest wall pressure. There was no significant difference between the two Vest™ systems. Since vosc dictates the effectiveness of HFCWO and since vosc is dependent on esophageal pulse pressure, which in turn is dependent on chest wall pulse pressure, it follows that the effectiveness of HFCWO is influenced by the ability to generate an effective chest wall pulse pressure.

Measurement of intrabronchial pressure in man

1965 ◽  
Vol 20 (4) ◽  
pp. 653-663 ◽  
Author(s):  
Peter T. Macklem ◽  
N. J. Wilson
Keyword(s):  
Lung Volume ◽  
Esophageal Pressure ◽  
Lung Mechanics ◽  
Pleural Pressure ◽  
Quiet Breathing ◽  
Airway Compression ◽  
Large Airways ◽  
Normal Man ◽  
Expiratory Flow ◽  
Intrabronchial Pressure

By measuring total and lateral airway pressures in intact normal man, simultaneously with esophageal pressure, volume, and flow, it was possible to estimate the pressure difference across the wall of the airway, the pressure-flow curves of various segments of the airway, and the compliance of the airway. The results showed that: 1 Expiratory airway compression only occurs between the segmental bronchi and the glottis at volumes between 75 and 25% VC. 2) Expiratory flow is limited by compression of these airways. 3) The resistance of airways between segmental bronchi and trachea is variable, being markedly affected both by lung volume and pleural pressure. Tracheal resistance varies little with lung volume, but considerably with pleural pressure. The resistance of the airways between alveoli and segmental bronchi varies with lung volume but little with pleural pressure. These are probably the major resistance airways during quiet breathing. 4) Airway compliance is inversely related to lung volume. 5) The Bernouilli effect is large in large airways and helps to limit expiratory flow. bronchial pressure; airway resistance; airway compliance; maximal expiratory flow; equal pressure point; lung mechanics; airway compression Submitted on November 5, 1964

scholarly journals Respiratory mechanical effects of surgical pneumoperitoneum in humans

2014 ◽  
Vol 117 (9) ◽  
pp. 1074-1079 ◽  
Author(s):  
Stephen H. Loring ◽  
Negin Behazin ◽  
Aileen Novero ◽  
Victor Novack ◽  
Stephanie B. Jones ◽  
...  
Keyword(s):  
Chest Wall ◽  
Respiratory System ◽  
Transpulmonary Pressure ◽  
Esophageal Pressure ◽  
Pleural Pressure ◽  
Abdominal Pressure ◽  
Positive End Expiratory Pressure ◽  
Before And After ◽  
Show Evidence ◽  
Obese Subjects

Pneumoperitoneum for laparoscopic surgery is known to stiffen the chest wall and respiratory system, but its effects on resting pleural pressure in humans are unknown. We hypothesized that pneumoperitoneum would raise abdominal pressure, push the diaphragm into the thorax, raise pleural pressure, and squeeze the lung, which would become stiffer at low volumes as in severe obesity. Nineteen predominantly obese laparoscopic patients without pulmonary disease were studied supine (level), under neuromuscular blockade, before and after insufflation of CO2 to a gas pressure of 20 cmH2O. Esophageal pressure (Pes) and airway pressure (Pao) were measured to estimate pleural pressure and transpulmonary pressure (Pl = Pao − Pes). Changes in relaxation volume (Vrel, at Pao = 0) were estimated from changes in expiratory reserve volume, the volume extracted between Vrel, and the volume at Pao = −25 cmH2O. Inflation pressure-volume (Pao-Vl) curves from Vrel were assessed for evidence of lung compression due to high Pl. Respiratory mechanics were measured during ventilation with a positive end-expiratory pressure of 0 and 7 cmH2O. Pneumoperitoneum stiffened the chest wall and the respiratory system (increased elastance), but did not stiffen the lung, and positive end-expiratory pressure reduced Ecw during pneumoperitoneum. Contrary to our expectations, pneumoperitoneum at Vrel did not significantly change Pes [8.7 (3.4) to 7.6 (3.2) cmH2O; means (SD)] or expiratory reserve volume [183 (142) to 155 (114) ml]. The inflation Pao-Vl curve above Vrel did not show evidence of increased lung compression with pneumoperitoneum. These results in predominantly obese subjects can be explained by the inspiratory effects of abdominal pressure on the rib cage.

Measurement of pleural pressure in neonates

1982 ◽  
Vol 52 (2) ◽  
pp. 491-494 ◽  
Author(s):  
M. I. Asher ◽  
A. L. Coates ◽  
J. M. Collinge ◽  
J. Milic-Emili
Keyword(s):  
Body Position ◽  
Balloon Catheter ◽  
Esophageal Pressure ◽  
Indirect Measurement ◽  
Pleural Pressure ◽  
Internal Diameter ◽  
Term Neonates ◽  
Esophageal Balloon ◽  
Airway Opening ◽  
Pressure Changes

The indirect measurement of pleural pressure in neonates is obtained from measurements of esophageal pressure (Pes) with either a liquid-filled catheter or an esophageal balloon-catheter system. The purpose of this investigation was to assess the validity of the water-filled esophageal catheter by comparing the simultaneous changes in Pes and airway opening pressure (Pao) during occluded respiratory efforts. Equal changes in Pes and Pao under this condition indicate that Pes is a valid measurement of pleural pressure. In six healthy unsedated term neonates (aged 2–3 days) we measured Pes in the lower third of the esophagus with a water-filled catheter of eight French gage (FC), which has a 2-mm internal diameter. During occlusions, changes in Pes and Pao were almost identical in magnitude and timing in each body position studied (right lateral, prone, and supine). We conclude that the water-filled 8-FG esophageal catheter gives an accurate measurement of pleural pressure changes in healthy neonates.

Mediastinal and chest wall limitations to asymmetry of lung inflation

2004 ◽  
Vol 96 (3) ◽  
pp. 999-1004 ◽  
Author(s):  
Ken C. Lin ◽  
Anna Dizner-Golab ◽  
Robert L. Thurer ◽  
Stephen H. Loring
Keyword(s):  
Lung Transplantation ◽  
Chest Wall ◽  
Balloon Catheter ◽  
Left Lung ◽  
Lung Ventilation ◽  
Esophageal Pressure ◽  
Pleural Pressure ◽  
Reduced Pressure ◽  
Lung Inflation ◽  
Left And Right

The extent to which inflation of one lung increases pleural pressure around the contralateral lung could affect ventilatory function, e.g., after pneumonectomy or lung transplantation. The rise in contralateral pleural pressure is limited by mediastinal stiffness and other chest wall properties. To estimate these properties, we determined an elastance of asymmetric expansion (EAsym) in 20 supine adults undergoing thoracic surgery requiring endobronchial intubation. Esophageal pressure, measured with a balloon catheter, was used as an estimate of pleural pressure for determining chest wall elastance during symmetric inflation. Pressures measured in the left and right lung airways during sequential asymmetric inflations with known volumes were used to calculate EAsymand elastances of left and right lungs by using a four-element mathematical model. Elastances (means ± SD) were 13.0 ± 8.7 (EAsym), 14.0 ± 7.0 (left lung), 12.2 ± 6.1 (right lung), and 6.7 ± 2.1 cmH2O/l (chest wall). EAsymwas high in three patients with prior cardiac surgery or mediastinal radiation therapy, suggesting that mediastinal stiffening due to scarring and fibrosis reduced pressure transmission between hemithoraxes. Simulations with a previously published model showed that changes in EAsymin the range of values observed could substantially affect lung ventilation after single-lung transplantation for emphysema.

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