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22.06.2016 | Review

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

verfasst von: 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 Brochard, Jordi Mancebo, the PLeUral pressure working Group (PLUG—Acute Respiratory Failure section of the European Society of Intensive Care Medicine)

Erschienen in: Intensive Care Medicine | Ausgabe 9/2016

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Abstract

Purpose

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.

Methods

This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes.

Results

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.

Conclusions

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.

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Titel: Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives
verfasst von: 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 Brochard
Jordi Mancebo
the PLeUral pressure working Group (PLUG—Acute Respiratory Failure section of the European Society of Intensive Care Medicine)
Publikationsdatum: 22.06.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 9/2016
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-016-4400-x

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