Esophageal Pressure in Acute Lung Injury

2009 ◽  
Vol 360 (8) ◽  
pp. 831-833
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Esophageal Pressure

scholarly journals End-expiratory esophageal pressure versus lower inflection point in acute lung injury

Critical Care ◽  
2013 ◽  
Vol 17 (S2) ◽  
Author(s):  
A Yaroshetskiy ◽  
D Protsenko ◽  
E Larin ◽  
O Ignatenko ◽  
B Gelfand
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Inflection Point ◽  
Esophageal Pressure ◽  
Lower Inflection Point

Using Esophageal Pressures to Improve Oxygenation and Compliance in Acute Lung Injury

2018 ◽  
pp. 163-169
Author(s):  
Connie Wang ◽  
Edward Bittner
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
New England ◽  
Transpulmonary Pressure ◽  
Standard Of Care ◽  
Esophageal Pressure ◽  
Optimal Level ◽  
Balloon Catheters ◽  
Alveolar Collapse

The New England Journal of Medicine article, “Using Esophageal Pressures to Improve Oxygenation and Compliance in Acute Lung Injury,” showed that ventilator adjustments guided by using esophageal pressure for estimation of transpulmonary pressure demonstrated significant improvement in oxygenation and compliance for patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The study randomized patients with ALI or ARDS to either a positive end expiration pressure (PEEP) adjustment according to measurement of either esophageal pressures or ARDS network standard-of-care recommendations. Esophageal balloon catheters helped to determine the optimal level of PEEP that would sustain oxygenation but still prevent alveolar collapse or overdistention.

Volume-related and volume-independent effects of posture on esophageal and transpulmonary pressures in healthy subjects

2006 ◽  
Vol 100 (3) ◽  
pp. 753-758 ◽  
Author(s):  
George R. Washko ◽  
Carl R. O'Donnell ◽  
Stephen H. Loring
Keyword(s):  
Acute Lung Injury ◽  
Lung Injury ◽  
Healthy Subjects ◽  
Balloon Catheter ◽  
Transpulmonary Pressure ◽  
Esophageal Pressure ◽  
Wide Range ◽  
Ventilator Management ◽  
Volume Characteristics ◽  
Independent Effects

Ventilator management decisions in acute lung injury could be better informed with knowledge of the patient's transpulmonary pressure, which can be estimated using measurements of esophageal pressure. Esophageal manometry is seldom used for this, however, in part because of a presumed postural artifact in the supine position. Here, we characterize the magnitude and variability of postural effects on esophageal pressure in healthy subjects to better assess its significance in patients with acute lung injury. We measured the posture-related changes in relaxation volume and total lung capacity in 10 healthy subjects in four postures: upright, supine, prone, and left lateral decubitus. Then, in the same subjects, we measured static pressure-volume characteristics of the lung over a wide range of lung volumes in each posture by using an esophageal balloon catheter. Transpulmonary pressure during relaxation (Plrel) averaged 3.7 (SD 2.0) cmH2O upright and −3.3 (SD 3.2) cmH2O supine. Approximately 58% of the decrease in Plrel between the upright and supine postures was due to a corresponding decrease in relaxation volume. The remaining 2.9-cmH2O difference is consistent with reported values of a presumed postural artifact. Relaxation volumes and pressures in prone and lateral postures were intermediate. To correct estimated transpulmonary pressure for the effect of lying supine, we suggest adding 3 cmH2O (95% confidence interval: −1 to +7 cmH2O). We conclude that postural differences in estimated transpulmonary pressure at a given lung volume are small compared with the substantial range of Plrel in patients with acute lung injury.

Primate Pleuroesophageal Tissue Barrier Frequency Response and Esophageal Pressure Waveform Bandwidth in Health and Acute Lung Injury

2000 ◽  
Vol 92 (2) ◽  
pp. 550-550
Author(s):  
Craig G. Hartford ◽  
Johan M. van Schalkwyk ◽  
Geoffrey G. Rogers ◽  
Martin J. Turner
Keyword(s):  
Mechanical Ventilation ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Frequency Response ◽  
Signal Transmission ◽  
Extreme Case ◽  
Esophageal Pressure ◽  
Lung Compliance ◽  
Accurate Estimation ◽  
Pressure Amplitude

Background Dynamic intraesophageal pressure (Pes) is used to estimate intrapleural pressure (Ppl) to calculate lung compliance and resistance. This study investigated the nonhuman primate Ppl-Pes tissue barrier frequency response and the dynamic response requirements of Pes manometers. Methods In healthy monkeys and monkeys with acute lung injury undergoing ventilation, simultaneous Ppl and Pes were measured directly to determine the Ppl-Pes tissue barrier amplitude frequency response, using the swept-sine wave technique. The bandwidths of physiologic Pes waveforms acquired during conventional mechanical ventilation were calculated using digital low-pass signal filtering. Results The Ppl-Pes tissue barrier is amplitude-uniform within the bandwidth of conventional Pes waveforms in healthy and acute lung injury lungs, and does not significantly attenuate Ppl-Pes signal transmission between 1 and 40 Hz. At Pes frequencies higher than conventional clinical regions of interest the Ppl-Pes barrier resonates significantly, is pressure amplitude dependent at low-pressure offsets, and is significantly altered by acute lung injury. Allowing for 5% or less Pes waveform error, the maximum Pes bandwidths during conventional ventilation were 1.9 Hz and 3.4 Hz for physiologic and extreme-case waveforms in healthy lungs and 4.6 Hz and 8.5 Hz during acute lung injury. Conclusions In monkeys, the Ppl-Pes tissue barrier has a frequency response suitable for Ppl estimation during low-frequency mechanical ventilation, and Pes manometers should have a minimum uniform frequency response up to 8.5 Hz. However, the Ppl-Pes tissue barrier adversely affects the accurate estimation of dynamic Ppl at high frequencies, with varied airway pressure amplitudes and offsets, such as the Ppl encountered during high-frequency oscillatory ventilation.

scholarly journals Mechanical Ventilation Guided by Esophageal Pressure in Acute Lung Injury

2008 ◽  
Vol 359 (20) ◽  
pp. 2095-2104 ◽  
Author(s):  
Daniel Talmor ◽  
Todd Sarge ◽  
Atul Malhotra ◽  
Carl R. O'Donnell ◽  
Ray Ritz ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Lung Injury ◽  
Lung Injury ◽  
Esophageal Pressure
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