Article (Scientific journals)
Novel method of transpulmonary pressure measurement with an air‑flled esophageal catheter
MASSION, Paul; Berg, Julien; SAMALEA SUAREZ, Nicolas et al.
2021In Intensive Care Medicine Experimental
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Keywords :
Esophageal pressure; Esophageal balloon catheter; Pleural pressure; Transpulmonary pressure; Acute respiratory distress syndrome; Lung-protective ventilation; Ventilator-induced lung injury; Patient self-inficted lung injury; Respiratory mechanics
Abstract :
[en] Background: There is a strong rationale for proposing transpulmonary pressureguided protective ventilation in acute respiratory distress syndrome. The reference esophageal balloon catheter method requires complex in vivo calibration, expertise and specifc material order. A simple, inexpensive, accurate and reproducible method of measuring esophageal pressure would greatly facilitate the measure of transpulmonary pressure to individualize protective ventilation in the intensive care unit. Results: We propose an air-flled esophageal catheter method without balloon, using a disposable catheter that allows reproducible esophageal pressure measurements. We use a 49-cm-long 10 Fr thin suction catheter, positioned in the lower-third of the esophagus and connected to an air-flled disposable blood pressure transducer bound to the monitor and pressurized by an air-flled infusion bag. Only simple calibration by zeroing the transducer to atmospheric pressure and unit conversion from mmHg to cmH2O are required. We compared our method with the reference balloon catheter both ex vivo, using pressure chambers, and in vivo, in 15 consecutive mechanically ventilated patients. Esophageal-to-airway pressure change ratios during the dynamic occlusion test were close to one (1.03±0.19 and 1.00±0.16 in the controlled and assisted modes, respectively), validating the proper esophageal positioning. The Bland– Altman analysis revealed no bias of our method compared with the reference and good precision for inspiratory, expiratory and delta esophageal pressure measurements in both the controlled (largest bias −0.5 cmH2O [95% confdence interval: −0.9; −0.1] cmH2O; largest limits of agreement −3.5 to 2.5 cmH2O) and assisted modes (largest bias −0.3 [−2.6; 2.0] cmH2O). We observed a good repeatability (intra-observer, intraclass correlation coefcient, ICC: 0.89 [0.79; 0.96]) and reproducibility (inter-observer ICC: 0.89 [0.76; 0.96]) of esophageal measurements. The direct comparison with pleural pressure in two patients and spectral analysis by Fourier transform confrmed the reliability of the air-flled catheter-derived esophageal pressure as an accurate surrogate of pleural pressure. A calculator for transpulmonary pressures is available online. Conclusions: We propose a simple, minimally invasive, inexpensive and reproducible method for esophageal pressure monitoring with an air-flled esophageal catheter without balloon. It holds the promise of widespread bedside use of transpulmonary pressure-guided protective ventilation in ICU patients.
Disciplines :
Anesthesia & intensive care
Author, co-author :
MASSION, Paul ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
Berg, Julien ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
SAMALEA SUAREZ, Nicolas ;  Centre Hospitalier Universitaire de Liège - CHU > Département d'Anesthésie et réanimation > Service d'anesthésie - réanimation
Parzibut, Gilles ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
LAMBERMONT, Bernard  ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
LEDOUX, Didier  ;  Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service des soins intensifs
MASSION, Pierre
Language :
English
Title :
Novel method of transpulmonary pressure measurement with an air‑flled esophageal catheter
Publication date :
2021
Journal title :
Intensive Care Medicine Experimental
eISSN :
2197-425X
Publisher :
Springer, New York, United States - New York
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 24 October 2021

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