Comparison of central venous, oesophageal and mouth occlusion pressure with water-filled catheters for estimating pleural pressure changes in healthy adults

Flémale, A.; C, Gillard; Dierckx, J. P.

doi:10.1183/09031936.93.01010051

Cited by 45 publications

(8 citation statements)

References 16 publications

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“…Almost all mechanically ventilated patients have a central venous access and we showed that the presence of a correctly placed CVC allowed, together with the presented algorithm of processed CVP, to obtain an estimation of respiratory swings of Ppl and P L without further devices. The idea of using the superior vena cava as an alternative site to the esophagus to record pleural pressure goes back to the 70's: con icting results emerged about the correlation between respiratory changes in CVP and P ES , and CVP was found to perform better [9], worse [29] or as good as P ES [30] in providing reliable measure of Ppl. Since different catheter-manometer systems were employed and CVP signal was not always processed, we cannot ultimately speculate about these past results.…”

Section: Discussionmentioning

confidence: 99%

Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients

Franchi,

Detti,

Fogagnolo

et al. 2023

Preprint

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Purpose: Transpulmonary pressure (PL) calculation requires esophageal pressure (PES) as a surrogate of pleural pressure (Ppl), but its calibration is a cumbersome technique. Central venous pressure (CVP) swings may reflect tidal variations in Ppl and could be used instead of PES, but the interpretation of CVP waveforms could be difficult due to superposition of heartbeat-induced pressure changes. Thus, we developed a digital filter able to remove the cardiac noise to obtain a filtered CVP (f-CVP). The aim of the study was to evaluate the accuracy of CVP and filtered CVP swings (ΔCVP and Δf-CVP, respectively) in estimating esophageal respiratory swings (ΔPES) and compare PL calculated with CVP, f-CVP and PES; then we tested the diagnostic accuracy of the f-CVP method to identify unsafe high PL levels. Methods: Twenty patients with acute respiratory failure (defined as PO2/FiO2 ratio below 200 mmHg) treated with invasive mechanical ventilation and monitored with esophageal balloon and central venous catheter were enrolled prospectively. For each patient a recording session at baseline was performed, repeated if a modification in ventilatory settings occurred. PES, CVP and airway pressure during an end-inspiratory and -expiratory pause were simultaneously recorded; CVP, f-CVP and PES waveforms were analyzed off-line and used to calculate transpulmonary pressure (PLCVP, PLf-CVP, PLPES, respectively). Results: Δf-CVP correlated better than ΔCVP with ΔPES (r=0.8, p=0.001 vs r=0.08, p=0.73), with a lower bias in Bland Altman analysis (mean bias -0.16, LoA -1.31, 0.98 cmH2O vs mean bias -0.79, LoA -3.14, 1.55 cmH2O). Both PLf-CVP and PLCVP correlated well with PLPES (r=0.98, p<0.001 vs r=0.94, p<0.001), again with a lower bias in Bland Altman analysis (0.15, LoA – 0.95, 1.26 cmH2O vs 0.80, LoA – 1.51, 3.12, cmH2O). PLf-CVP discriminated high PL value with an area under the receiver operating characteristic curve 0.99 (standard deviation, SD, 0.02) (AUC difference= 0.01 [-0.024; 0.05], p= 0.48). Conclusions: In mechanically ventilated patients with acute respiratory failure, Δf-CVP estimated ΔPES and PL obtained from digital filtered CVP represented a reliable value of standard PL measured with the esophageal method and could identify patients with non-protective ventilation settings.

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Section: Discussionmentioning

confidence: 99%

Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients

Franchi,

Detti,

Fogagnolo

et al. 2023

Preprint

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“…The evaluation of CVP swings and their correlation with Ppl variations during tidal ventilation were also investigated in spontaneously breathing patients. Flemale et al [ 35 ] compared ΔCVP, ΔPes and mouth occlusion pressure respiratory changes (ΔPm) as an estimate of ΔPpl in 10 healthy adults in different body positions during inspiratory efforts against occluded airways. In that study, ΔPm during the occlusion test was considered representative of ΔPpl according to previous findings [ 46 , 47 ].…”

Section: Clinical Studiesmentioning

confidence: 99%

“…First, two different systems are compared: one filled with fluid (central venous catheter) and one filled with air (esophageal balloon). Only one of the quoted studies [ 35 ] analyzed ΔCVP and ΔPes with the same fluid-filled system and showed that the central venous catheter as compared to a fluid-filled esophageal catheter provides a valid assessment of ΔPpl in healthy adults during spontaneous breathing. Nevertheless, in the more recent studies where ΔCVP and ΔPes were measured with different systems, a correlation was consistently found between these two parameters.…”

Section: Clinical Studiesmentioning

confidence: 99%

Respiratory Variations of Central Venous Pressure as Indices of Pleural Pressure Swings: A Narrative Review

2023

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The measurement of pleural (or intrathoracic) pressure is a key element for a proper setting of mechanical ventilator assistance as both under- and over-assistance may cause detrimental effects on both the lungs and the diaphragm. Esophageal pressure (Pes) is the gold standard tool for such measurements; however, it is invasive and seldom used in daily practice, and easier, bedside-available tools that allow for rapid and continuous monitoring are greatly needed. The tidal swing of central venous pressure (CVP) has long been proposed as a surrogate for pleural pressure (Ppl); however, despite the wide availability of central venous catheters, this variable is very often overlooked in critically ill patients. In the present narrative review, the physiological basis for the use of CVP waveforms to estimate Ppl is presented; the findings of previous and recent papers that addressed this topic are systematically reviewed, and the studies are divided into those reporting positive findings (i.e., CVP was found to be a reliable estimate of Pes or Ppl) and those reporting negative findings. Both the strength and pitfalls of this approach are highlighted, and the current knowledge gaps and direction for future research are delineated.

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“…UARS leads to sleep fragmentation and negative daytime repercussions (excessive sleepiness, tiredness and fatigue). The characteristic phenomenon of this condition is the awakening associated with RERA, measured by PSG coupled to an esophageal manometry sensor, or with a nasal pressure transducer cannula [220][221][222] .…”

Section: Upper Airway Resistance Syndromementioning

confidence: 99%

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

Frange¹,

Franco²,

Brasil³

et al. 2022

Sleep Sci

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This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.

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Comparison of central venous, oesophageal and mouth occlusion pressure with water-filled catheters for estimating pleural pressure changes in healthy adults

Cited by 45 publications

References 16 publications

Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients

Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients

Respiratory Variations of Central Venous Pressure as Indices of Pleural Pressure Swings: A Narrative Review

Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines

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