Does esophageal pressure monitoring reliably permit to estimate transpulmonary pressure in children?

Manipulation of positive end-expiratory pressure (PEEP) has been shown to improve the outcome in pediatric acute respiratory distress syndrome (PARDS), but the “ideal” PEEP, in which the compliance and oxygenation are maximized, while overdistension and undesirable hemodynamic effects are minimized, is yet to be determined. Also, for a given level of PEEP, transpulmonary pressure (TPP) may vary unpredictably from patient to patient. Patients with high pleural pressure who are on conventional ventilator settings under inflation may cause hypoxemia. In such patients, raising PEEP to maintain a positive TPP might improve aeration and oxygenation without causing overdistension. We report a case of PARDS, who was managed using real-time esophageal pressure monitoring using the AVEA ventilator and thereby adjusting PEEP to maintain the positive TPP.

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Weaning Prediction: Esophageal Pressure Monitoring Complements Readiness Testing

Yearbook of Critical Care Medicine ◽

10.1016/s0734-3299(08)70032-7 ◽

2006 ◽

Vol 2006 ◽

pp. 39-40

Author(s):

R.P. Dellinger

Keyword(s):

Esophageal Pressure ◽

Pressure Monitoring

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Mechanics of the respiratory system and breathing pattern during sleep in normal humans

Journal of Applied Physiology ◽

10.1152/jappl.1984.56.1.133 ◽

1984 ◽

Vol 56 (1) ◽

pp. 133-137 ◽

Cited By ~ 177

Author(s):

D. W. Hudgel ◽

R. J. Martin ◽

B. Johnson ◽

P. Hill

Keyword(s):

Eye Movement ◽

Rem Sleep ◽

Breathing Pattern ◽

Minute Ventilation ◽

Transpulmonary Pressure ◽

Dynamic Compliance ◽

Face Mask ◽

Esophageal Pressure ◽

Rapid Eye Movement ◽

Airflow Resistance

The purposes of this investigation were to describe the changes in 1) dynamic compliance of the lungs, 2) airflow resistance, and 3) breathing pattern that occur during sleep in normal adult humans. Six subjects wore a tightly fitting face mask. Flow and volume were obtained from a pneumotachograph attached to the face mask. Transpulmonary pressure was calculated as the difference between esophageal pressure obtained with a balloon and mask pressure. At least 20 consecutive breaths were analyzed for dynamic compliance, airflow resistance, and breathing pattern during wakefulness, non-rapid-eye-movement stage 2 and rapid-eye-movement (REM) sleep. Dynamic compliance did not change significantly. Airflow resistance increased during sleep; resistance was 3.93 +/- 0.56 cmH2O X 1–1 X s during wakefulness, 7.96 +/- 0.95 in stage 2 sleep, and 8.66 +/- 1.43 in REM sleep (P less than 0.02). By placing a catheter in the retroepiglottic space and thus dividing the airway into upper and lower zones, we found the increase in resistance occurred almost entirely above the larynx. Decreases in tidal volume, minute ventilation, and mean inspiratory flow observed during sleep were not statistically significant.

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Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.4764 ◽

2015 ◽

Vol 11 (06) ◽

pp. 597-602 ◽

Cited By ~ 5

Author(s):

Virginia Skiba ◽

Cathy Goldstein ◽

Helena Schotland

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Disordered Breathing ◽

Esophageal Pressure ◽

Pressure Monitoring ◽

Obstructive Sleep ◽

Disordered Breathing

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Forces involved in lobar atelectasis in intact dogs

Journal of Applied Physiology ◽

10.1152/jappl.1980.48.1.29 ◽

1980 ◽

Vol 48 (1) ◽

pp. 29-33 ◽

Cited By ~ 10

Author(s):

G. T. Ford ◽

C. A. Bradley ◽

N. R. Anthonisen

Keyword(s):

Chest Wall ◽

Lower Lobe ◽

Transpulmonary Pressure ◽

Esophageal Pressure ◽

Lateral Position ◽

Relative Volume ◽

Left Lower Lobe ◽

Lung Lobe ◽

Left Lateral Position ◽

The Difference

When an excised lung lobe undergoes atelectasis, its shape differs from that observed when lobar atelectasis occurs in an intact animal: the chest wall deforms the collapsing lobe. In eight anesthetized dogs in the left lateral position we measured lung volume and transpulmonary pressure during the development of atelectasis. We then induced atelectasis of the left lower lobe with the rest of the lung maintained at FRC and measured lobar volume and "translobar" (lobar minus esophageal) pressure. Lung and lobar volumes were measured by prebreathing the animal with 88% O2-12% N2, occluding the airway and observing the increase in lung or lobar N2 concentration. When the left lower lobe alone collapsed, translobar pressures were more negative than transpulmonary pressure at the same relative volume when the whole lung collapsed. This pressure difference, which represents the deforming force applied to the lobe minus the pressure costs of deformation, averaged 3 cmH2O at 50% FRC. Infusion of 25 ml of normal saline into the pleural space sharply reduced the difference pulmonary pressure during lung collapse: this difference was abolished at 80% FRC and halved at 50% FRC. The large effect of the small volume of fluid suggested that deforming forces were largely generated in relatively local areas, such as regions of the chest wall with sharp angulation.

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Effect of the chest wall and blood volume on pulmonary distensibility

Journal of Applied Physiology ◽

10.1152/jappl.1992.72.1.186 ◽

1992 ◽

Vol 72 (1) ◽

pp. 186-193 ◽

Cited By ~ 2

Author(s):

H. J. Colebatch ◽

C. K. Ng ◽

N. Berend ◽

F. J. Maccioni

Keyword(s):

Chest Wall ◽

Blood Volume ◽

Surface Pressure ◽

Supine Position ◽

Transpulmonary Pressure ◽

Esophageal Pressure ◽

Relative Increase ◽

Alveolar Volume ◽

Pulmonary Blood Volume ◽

Gas Volume

To determine the reason for increased pulmonary distensibility in excised lungs, we performed deflation pressure-volume (PV) studies in 24 dogs. Exponential analysis of PV data gave K, an index of distensibility. Lung volume was measured by dilution of neon. Compared with measurements obtained in the supine position, with the chest closed, and with esophageal pressure (Pes) to obtain transpulmonary pressure, K was not changed significantly with the chest strapped, with pleural pressure to obtain transpulmonary pressure, or with the chest open. From displacement of PV curves obtained in the supine position and with the chest closed or open, we estimated that Pes was 0.18 kPa greater than average lung surface pressure. An increase in K in the prone and head-up positions was attributed to a traction artifact decreasing Pes. Exsanguination increased K and produced a relative increase in gas volume. These results show that overall pulmonary distensibility is unaffected by an intact chest wall. An increase in K and gas volume after exsanguination probably reflects a decreased pulmonary blood volume, with collapse of capillaries increasing the alveolar volume-to-surface ratio.

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