Esophageal Manometry and Regional Transpulmonary Pressure in Lung Injury

• DOI: 10.1164/rccm.201709-1806oc
• Publication Date: 2018-01-11T17:35:15Z
• Authors: Takeshi Yoshida; Marcelo B. P. Amato; Domenico Luca Grieco; Lu Chen; Cristhiano A. S. ...; Rollin Roldan; Caio C. A. Morais; Susimeire Gomes; Eduardo L. V. Costa; Paulo F. G. Cardoso; Emmanuel Charbonney; Jean-Christophe M...; Laurent Brochard; Brian P. Kavanagh
• Keywords: Transpulmonary pressure; Atelectasis

Rationale: Esophageal manometry is the clinically available method to estimate pleural pressure, thus enabling calculation of transpulmonary pressure (Pl). However, many concerns make it uncertain in which lung region esophageal reflects local Pl.Objectives: To determine accuracy (Pes) and regions (Ppl) Pl; assess whether stress nondependent can be estimated at end-inspiration from Pl.Methods: In lung-injured pigs (n = 6) human cadavers 3), Pes was measured across a range positive end-expiratory together with directly Ppl dependent regions. All measurements were obtained minimal nonstressed volumes sensors balloons. Expiratory inspiratory Pl calculated by subtracting or airway pressure; also (calculated chest wall respiratory system elastance) plateau pressure.Measurements Main Results: cadavers, expiratory using closely reflected values middle (adjacent esophagus). Inspiratory elastance ratio values.Conclusions: These data support use acute distress syndrome. Assuming correct calibration, derived lung, where atelectasis usually predominates; may indicate highest level “baby” vulnerable ventilator-induced injury.