TY - JOUR
T1 - Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives
AU - Mauri, Tommaso
AU - Yoshida, Takeshi
AU - Bellani, Giacomo
AU - Goligher, Ewan C.
AU - Carteaux, Guillaume
AU - Rittayamai, Nuttapol
AU - Mojoli, Francesco
AU - Chiumello, Davide
AU - Piquilloud, Lise
AU - Grasso, Salvatore
AU - Jubran, Amal
AU - Laghi, Franco
AU - Magder, Sheldon
AU - Pesenti, Antonio
AU - Loring, Stephen
AU - Gattinoni, Luciano
AU - Talmor, Daniel
AU - Blanch, Lluis
AU - Amato, Marcelo
AU - Chen, Lu
AU - Brochard, Laurent
AU - Mancebo, Jordi
PY - 2016/9/1
Y1 - 2016/9/1
N2 - © 2016, Springer-Verlag Berlin Heidelberg and ESICM. 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.
AB - © 2016, Springer-Verlag Berlin Heidelberg and ESICM. 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.
KW - Acute respiratory distress syndrome
KW - Acute respiratory failure
KW - Esophageal pressure
KW - Mechanical ventilation
KW - Physiologic monitoring
U2 - 10.1007/s00134-016-4400-x
DO - 10.1007/s00134-016-4400-x
M3 - Review article
VL - 42
SP - 1360
EP - 1373
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 9
ER -