Two steps forward in bedside monitoring of lung mechanics: transpulmonary pressure and lung volume

Cortes, Gustavo; Marini, John J.

doi:10.1186/cc12528

Cited by 26 publications

(11 citation statements)

References 36 publications

(61 reference statements)

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“…17 However, esophageal balloon estimation of pleural pressure can be influenced by several factors, including body position, intra-abdominal pressure, and different lung conditions. 18 Thus, P plat measurement remains important and practical, and its interpretation should take these factors into consideration.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Plateau Pressure Below 30 cm H₂O in Septic Subjects With Acute Respiratory Failure

et al. 2014

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BACKGROUND: Ventilation with low tidal volume is recommended for patients with acute lung injury. Current guidelines suggest limiting plateau pressure (P plat ) to < 30 cm H 2 O for septic patients needing mechanical ventilation. The aim of this study was to determine whether P plat within the first 24 h of ICU admission is predictive of outcome and whether P plat < 30 cm H 2 O is associated with lower mortality rates. METHODS: This study was a retrospective analysis of prospectively acquired clinical data from an ICU of a tertiary referral hospital in central Taiwan. Subjects were included if they were admitted due to sepsis and respiratory failure requiring mechanical ventilation from April 2008 to November 2009. RESULTS: There were 220 subjects (188 males, 32 females) with a median age of 76 y and a mean Acute Physiology and Chronic Health Evaluation II score of 25.0 ؎ 6.5. Pneumonia was the major cause of sepsis (85.5%). The hospital mortality rate was 39.1%. P plat was higher throughout the first 24 h of ICU admission in nonsurvivors. Higher P plat was associated with higher mortality rates regardless of acute lung injury. In multivariate regression analysis, P plat > 25 cm H 2 O at 24 h after admission was an independent risk factor for mortality (adjusted odds ratio of 2.33, 95% CI 1.10 -4.91, P ‫؍‬ .03 for hospital mortality). CONCLUSIONS: P plat within the first 24 h of ICU admission is predictive of outcome, with lower P plat associated with lower mortality rates. There is no safety margin for P plat . Limiting P plat should be considered even at < 30 cm H 2 O in septic patients with acute respiratory failure.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Plateau Pressure Below 30 cm H₂O in Septic Subjects With Acute Respiratory Failure

et al. 2014

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“…Either inflating the lung with positive pressure during tidal breathing or adding 10 cm H 2 O PEEP caused the calculated P TP to convert from negative to neutral or positive values in all horizontal positions, with or without PLEF. Such conversion suggests the reopening of alveoli within the vicinity of the esophageal balloon and has been advocated as a marker by which to determine the PEEP needed to maintain recruitment and avoid regional tissue collapse in ARDS [ 3 ]. When supine, the vulnerability of P ES to compression under mediastinal weight (relieved by lung expansion at PEEP10) might offer an alternative explanation of P TP behavior in response to PEEP that is less tightly linked or even uncoupled from airspace closure [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Unilateral mechanical asymmetry: positional effects on lung volumes and transpulmonary pressure

Cortes-Puentes

Gard

Keenan

et al. 2014

ICMx

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BackgroundVentilated patients with asymmetry of lung or chest wall mechanics may be vulnerable to differing lung stresses or strains dependent on body position. Our purpose was to examine transpulmonary pressure (PTP) and end-expiratory lung volume (functional residual capacity (FRC)) during body positioning changes in an animal model under the influence of positive end-expiratory pressure (PEEP) or experimental pleural effusion (PLEF).MethodsFourteen deeply anesthetized swine were studied including tracheostomy, thoracostomy, and esophageal catheter placement. Animals were ventilated at VT = 10 ml/kg, frequency of 15, I/E = 1:2, and FIO2 = 0.5. The animals were randomized to supine, prone, right lateral, left lateral, and semi-Fowler positions with a PEEP of 1 cm H2O (PEEP1) or a PEEP of 10 cm H2O (PEEP10) applied. Experimental PLEF was generated by 10 ml/kg saline instilled into either pleural space. PTP and FRC were determined in each condition.ResultsNo significant differences in FRC were found among the four horizontal positions. Compared to horizontal positioning, semi-Fowler's increased FRC (p < 0.001) by 56% at PEEP1 and 54% at PEEP10 without PLEF and by 131% at PEEP1 and 98% at PEEP10 with PLEF. Inspiratory or expiratory PTP showed insignificant differences across positions at both levels of PEEP. Consistently negative end-expiratory PTP at PEEP1 increased to positive values with PEEP10.ConclusionsFRC did not differ among horizontal positions; however, semi-Fowler's positioning significantly raised FRC. PTP proved insensitive to mechanical asymmetry. While end-expiratory PTP was negative at PEEP1, applying PEEP10 caused a transition to positive PTP, suggestive of reopening of initially compressed lung units.Electronic supplementary materialThe online version of this article (doi:10.1186/2197-425X-2-4) contains supplementary material, which is available to authorized users.

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“…4,5 The success of these strategies is attributed to the reduction of transpulmonary pressure (P tp ), decreasing pulmonary mechanical stress, and barotrauma. 6 Secondly, the addition of PEEP and the use of recruitment manoeuvres counterbalance anaesthesia-related formation of atelectasis 7,8 and reduces atelectasis-induced postoperative pulmonary complications.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

Influence of xenon on pulmonary mechanics and lung aeration in patients with healthy lungs

Schaefer

Treschan

Gauch

et al. 2018

British Journal of Anaesthesia

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Two steps forward in bedside monitoring of lung mechanics: transpulmonary pressure and lung volume

Cited by 26 publications

References 36 publications

Prognostic Value of Plateau Pressure Below 30 cm H₂O in Septic Subjects With Acute Respiratory Failure

Prognostic Value of Plateau Pressure Below 30 cm H₂O in Septic Subjects With Acute Respiratory Failure

Unilateral mechanical asymmetry: positional effects on lung volumes and transpulmonary pressure

Influence of xenon on pulmonary mechanics and lung aeration in patients with healthy lungs

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Two steps forward in bedside monitoring of lung mechanics: transpulmonary pressure and lung volume

Cited by 26 publications

References 36 publications

Prognostic Value of Plateau Pressure Below 30 cm H2O in Septic Subjects With Acute Respiratory Failure

Prognostic Value of Plateau Pressure Below 30 cm H2O in Septic Subjects With Acute Respiratory Failure

Unilateral mechanical asymmetry: positional effects on lung volumes and transpulmonary pressure

Influence of xenon on pulmonary mechanics and lung aeration in patients with healthy lungs

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Prognostic Value of Plateau Pressure Below 30 cm H₂O in Septic Subjects With Acute Respiratory Failure

Prognostic Value of Plateau Pressure Below 30 cm H₂O in Septic Subjects With Acute Respiratory Failure