The oesophageal balloon for respiratory monitoring in ventilated patients: updated clinical review and practical aspects

Abstract

There is a well-recognised importance for personalising mechanical ventilation settings to protect the lungs and the diaphragm for each individual patient. Measurement of oesophageal pressure (Poes) as an estimate of pleural pressure allows assessment of partitioned respiratory mechanics and quantification of lung stress, which helps our understanding of the patient's respiratory physiology and could guide individualisation of ventilator settings. Oesophageal manometry also allows breathing effort quantification, which could contribute to improving settings during assisted ventilation and mechanical ventilation weaning. In parallel with technological improvements,Poesmonitoring is now available for daily clinical practice. This review provides a fundamental understanding of the relevant physiological concepts that can be assessed usingPoesmeasurements, both during spontaneous breathing and mechanical ventilation. We also present a practical approach for implementing oesophageal manometry at the bedside. While more clinical data are awaited to confirm the benefits ofPoes-guided mechanical ventilation and to determine optimal targets under different conditions, we discuss potential practical approaches, including positive end-expiratory pressure setting in controlled ventilation and assessment of inspiratory effort during assisted modes.

The effects of real-time waveform analysis software on patient ventilator synchronization during pressure support ventilation: a randomized crossover physiological study

“…The balloon was filled with 1 mL of air according to the manufacturer’s instructions and connected to a pressure transducer (BIOPAC Systems, Gotela, California, USA). The position of the esophageal balloon was checked by applying gentle pressure on the abdomen to verify the absence of fluctuating gastric pressure, then an occlusion test was performed to confirm the position [ 17 , 18 ]. P es was recorded with an MP150 Data Acquisition System (BIOPAC Systems, Gotela, California, USA).…”

Advanced Respiratory Monitoring during Extracorporeal Membrane Oxygenation

“…When assessed without airflow, Pl signifies the pressure acting solely on the lung, assuming open airways [17]. Ensuring the reliability of Pes measurements is paramount, with this requiring adherence to a series of meticulous steps [19]. Correct positioning is verified by observing changes in the tracing pattern, indicative of passive or spontaneously breathing patients.…”

Airway pressure release ventilation for lung protection in acute respiratory distress syndrome: an alternative way to recruit the lungs

“…No additional assistance in the form of pressure support is generally necessary. The lengthening of the T high and transition to CPAP depends on the patient's response and work of breathing, that is, respiratory drive (P0.1), effort (the delta occlusion pressure – Δ P occ via an expiratory occlusion manoeuvre [53], rapid shallow breath index [54], or if available oesophageal pressure swings) and presence of a regular spontaneous respiratory rate [55,56,57 ▪▪ ]. The acutely injured lung may remain time-dependent and pressure-dependent for a period of hours to days, even when the chest radiograph, arterial blood gases, and lung compliance suggest otherwise.…”