Influence of chest wall distortion on esophageal pressure

Lesouëf, Peter; Lopes, José Maria de Andrade; England, S. J.; Bryan, M. H.; Bryan, A. C.

doi:10.1152/jappl.1983.55.2.353

Cited by 144 publications

(43 citation statements)

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“…Our findings measuring esophageal pressure at two sites simultaneously in a group of preterm infants of similar birth weight and gestational age as in the study of Le Souef et al (10) do not support this interpretation. Nor is this interpretation supported by two recent studies (9,16).…”

Section: )contrasting

confidence: 94%

“…Although some investigators describe a good correlation between airway and esophageal pressure in neonates during airway occlusion (8,9), others have found this correlation highly variable (6,7). A differencebetween airway and esophageal pressure changes during occlusion has been observed especially in infants with lung disease (6) and chest wall distortion (10). It has been theorized that chest wall distortion leads to an unequal distribution of pleural pressure and that esophageal pressure, as a consequence, may not reflect mean pleural pressure changes (10).…”

mentioning

confidence: 99%

“…A differencebetween airway and esophageal pressure changes during occlusion has been observed especially in infants with lung disease (6) and chest wall distortion (10). It has been theorized that chest wall distortion leads to an unequal distribution of pleural pressure and that esophageal pressure, as a consequence, may not reflect mean pleural pressure changes (10). This interpretation is supported by the observation that the relationship of esophageal to airway pressure during airway occlusion may vary with the position of the tip of the esophageal catheter (10).…”

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confidence: 99%

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Influence of Chest Wall Distortion and Esophageal Catheter Position on Esophageal Manometry in Preterm Infants

et al. 1995

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The purpose of this stud y was to determine the effect of chest wall distortion on esophageal manometry by measuring simultaneous esophageal pressure changes at two sites in preterm infants . Fourteen infants were studied (mean ± SD: birth weight, 1340 ± 260 g; age, 8.5 ± 4 d). Esoph ageal pressure was measured through two water-filled catheters, one placed just above the cardia (Pes1) and the other at the level of the carina (Pes2) . Chest wall distortion was measured by inductance plethysmography, and inspiratory and expiratory flow by pneumotachography. No significant differences were found between the peak to peak esophageal pressure changes measured through the lower and higher catheters during both airwa y occlusion (18.7 ± 4.4 versus 18.3 ± 2.6 em H 20) and spontaneous breathing (9.4 ± 1.8 versus 9.0 ± 1.8 ern H 20) , although half of the infants had significant chest wall distortion. Mean pulmonary compliance and resistance measures calcul ated from the two pressures for individual infants showed small differences consistent with the difference between Pes1 and Pes2. For the whole group of 14 infants, however, these differences were not significant. TheThe determination of pulmonary compliance and resistance in spontaneously breathing infants requires reliable measurements of pleural pressure changes simultaneously with tidal flow and volume. From observations made in adults and experiment al animals it is assumed that esophageal pressure changes accurately reflect changes in pleural pressure (1-3). This assumption can easily be tested clinicall y by occluding the airway at its opening . The resulting tidal pressure swings in the airway almost equal the pleural pressure swings because both alveolar volume change and gas flow in the airways are minimal, so that pressure losses from overcoming elastic and resistant forces are negligible. Esophageal pressure swings recorded simultaneously are of similar magnitude as the pressure changes measured at the airway opening indicating that

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Section: )contrasting

confidence: 94%

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confidence: 99%

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confidence: 99%

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Influence of Chest Wall Distortion and Esophageal Catheter Position on Esophageal Manometry in Preterm Infants

et al. 1995

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“…In our subjects this condition was found present at all levels of CPAP (see "Methods"), and so gives confidence in the method. Although cyclical changes in Pes may not accurately reflect cyclical changes of pleural pressure at all levels of the lung in premature infants (16), the present measurements are a good reflection of pleural pressure at the level of the heart.…”

Section: Discussionmentioning

confidence: 57%

Optimal Constant Positive Airway Pressure Assessed by Arterial Alveolar Difference for CO2 in Hyaline Membrane Disease

et al. 1986

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“…The measurement of Pes in the presence of CWD has been described as unreliable, because it may reflect local pleural pressure changes rather than a mean pressure change (29). However, we reexamined this question recently and found that CWD does not affect Pes measurements adversely (30,31).…”

Section: Discussionmentioning

confidence: 79%

Proportional Assist Ventilation Decreases Thoracoabdominal Asynchrony and Chest Wall Distortion in Preterm Infants

et al. 2001

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Thoracoabdominal asynchrony (TAA) and chest wall distortion (CWD) are commonly seen in preterm infants secondary to a highly compliant rib cage and poor compensation of distorting forces by inspiratory rib cage muscles. Continuous positive airway pressure (CPAP) reduces TAA and CWD by stenting the chest wall. We hypothesized that application of positive airway pressure only during inspiration and in proportion to an infant's inspiratory effort should have a similar but more pronounced effect than CPAP alone. A ventilator providing airway pressure changes in proportion to flow and volume generated by an infant (proportional assist ventilation) was used to unload the respiratory pump during inspiration. Ten preterm infants were studied [birth weight, 745 (635-1175) g; gestational age, 26.5 (24 -31) wk; postnatal age 3 (1-7) d; medium (range)]. TAA and CWD were determined by respiratory inductive plethysmography. TAA was expressed as the phase angle between the rib cage and abdominal motion and CWD as the total compartmental displacement ratio. In addition, we measured tidal volume with a pneumotachograph and esophageal and airway pressure deflections with pressure transducers. Measurements were obtained during alternating periods of CPAP and two different degrees of support (Gain 1 ϭ 1.09 Ϯ 0.68, Gain 2 ϭ 1.84 Ϯ 0.84 cm H 2 O/mL) that were provided by a proportional assist ventilator. Phase angle and the total compartmental displacement ratio decreased with increasing gain compared with CPAP alone. Peak airway pressure increased from 0.6 to 3.8 to 7.6 cm H 2 O above positive end-expiratory pressure (PEEP) with CPAP, Gain 1, and Gain 2, respectively, as tidal volume increased from 2.8 to 4.1 to 4.7 mL/kg. Esophageal pressure changes decreased only little with increasing gain. Chest wall excursion increased and abdominal movement decreased, indicating a redistribution of tidal volume between chest and abdomen. We conclude that proportional assist ventilation reduces TAA and CWD by generating a small increase in airway pressure that occurs in synchrony and in proportion to each inspiratory effort. TAA, in which the rib cage and abdomen move out of phase due to inward CWD, are commonly seen in spontaneously breathing preterm infants. TAA and CWD are more pronounced in the presence of decreased lung compliance or increased airway resistance but can also be seen in preterm infants without lung disease or in term infants during REM sleep (1-4). The phenomenon is caused by mainly two factors: the negativity of the pleural pressure generated during inspiration and the compliance of the chest wall (5-7). For the chest wall to move along the pressure/volume curve seen during passive inflation of the respiratory system, active compensation from the inspiratory chest wall muscles, counteracting the distorting pleural force, is necessary (8). It has been shown that the more immature the infants are, the less well developed is their active compensation (9). It may be completely absent in very immature infants, leading to a 180...

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Influence of chest wall distortion on esophageal pressure

Cited by 144 publications

References 0 publications

Influence of Chest Wall Distortion and Esophageal Catheter Position on Esophageal Manometry in Preterm Infants

Influence of Chest Wall Distortion and Esophageal Catheter Position on Esophageal Manometry in Preterm Infants

Optimal Constant Positive Airway Pressure Assessed by Arterial Alveolar Difference for CO2 in Hyaline Membrane Disease

Proportional Assist Ventilation Decreases Thoracoabdominal Asynchrony and Chest Wall Distortion in Preterm Infants

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