Detection of strong inspiratory efforts from the analysis of central venous pressure swings: a preliminary clinical study

Colombo, Jacopo; Spinelli, Elena; Grasselli, Giacomo; Protti, Alessandro

doi:10.23736/s0375-9393.20.14323-2

Cited by 14 publications

(13 citation statements)

References 40 publications

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“…Furthermore, CVP showed a good performance for measuring WOB (r 2 = 0.89) and intrathoracic pressure swings (r 2 = 0.75) when compared to Pes. Similar conclusions were reported in a recent study by Colombo et al [ 39 ]. Assuming that ΔCVP may reflect ΔPpl, ΔPes and, therefore, the strength of inspirations, the authors aimed to determine the diagnostic accuracy of ΔCVP for strong inspiratory efforts (arbitrarily defined as ΔPes >8 mmHg).…”

Section: Clinical Studiessupporting

confidence: 93%

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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Section: Clinical Studiessupporting

confidence: 93%

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

2023

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“…Invasive mechanical ventilation with individually tailored tidal volume and airway pressure can be the safest option for patients with severe respiratory distress Underestimating the risks of spontaneous breathing in patients assisted by a ventilator Recognizing and mitigating vigorous inspiratory efforts and frequent asynchronies can be extremely difficult. In case of doubt, esophageal pressure swings [ 4 ] (or central venous pressure swings as a surrogate [ 15 ]) should be measured, and controlled ventilation started or resumed Herein we list some mistakes we made and some lessons we learned during the first waves of the pandemic. The way we treat patients with COVID-19 has changed accordingly.…”

Section: Iatrogenic Proceduresmentioning

confidence: 99%

Pulmonary air leak in COVID-19: time to learn from our mistakes

Benzarti

Protti

2022

Intensive Care Med

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“…In a recent editorial regarding respiratory treatment of COVID-19, in the absence of an esophageal catheter, the use of the swings of CVP as a surrogate measure for the work of breathing was recommended [25]. Although ΔCVP was correlated with ΔPes in previous studies [11,13], many studies have shown that ΔCVP did not usually reflect the exact value of ΔPes [10,12,[14][15][16][17][18]. Lung volume, chest wall elastance, chest wall distortion, and volume status including CVP and air trapping may affect the relationships between ΔPpl, ΔPes, and ΔCVP [12,21,[26][27][28][29].…”

Section: Plos Onementioning

confidence: 99%

“…Lung volume, chest wall elastance, chest wall distortion, and volume status including CVP and air trapping may affect the relationships between ΔPpl, ΔPes, and ΔCVP [12,21,[26][27][28][29]. As a result, the reported values of ΔPes/ΔCVP were not consistent and, more importantly, varied widely among individuals [10][11][12][13][14][15][16][17]. To overcome this problem, we used the ratio of ΔPpl to ΔCVP during an occlusion test to correct the raw ΔCVP values and estimate ΔPpl more accurately than when simply using ΔCVP.…”

Section: Plos Onementioning

confidence: 99%

“…However, the measurement of Pes is complicated by technical issues, including those related to the correct positioning of the esophageal catheter, interpretation of absolute Pes values, and balloon volume [8,9]. As a potential surrogate for the detecting the change in Ppl (ΔPpl) or strong inspiratory efforts, the change in central venous pressure (ΔCVP) has been repeatedly examined [10][11][12][13][14][15][16][17][18]. However, inconsistent results in previous papers have shown ΔCVP to be both an underestimation and an overestimation of ΔPpl [10,12,[14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Estimation of change in pleural pressure in assisted and unassisted spontaneous breathing pediatric patients using fluctuation of central venous pressure: A preliminary study

et al. 2021

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Background It is important to evaluate the size of respiratory effort to prevent patient self-inflicted lung injury and ventilator-induced diaphragmatic dysfunction. Esophageal pressure (Pes) measurement is the gold standard for estimating respiratory effort, but it is complicated by technical issues. We previously reported that a change in pleural pressure (ΔPpl) could be estimated without measuring Pes using change in CVP (ΔCVP) that has been adjusted with a simple correction among mechanically ventilated, paralyzed pediatric patients. This study aimed to determine whether our method can be used to estimate ΔPpl in assisted and unassisted spontaneous breathing patients during mechanical ventilation. Methods The study included hemodynamically stable children (aged <18 years) who were mechanically ventilated, had spontaneous breathing, and had a central venous catheter and esophageal balloon catheter in place. We measured the change in Pes (ΔPes), ΔCVP, and ΔPpl that was calculated using a corrected ΔCVP (cΔCVP-derived ΔPpl) under three pressure support levels (10, 5, and 0 cmH2O). The cΔCVP-derived ΔPpl value was calculated as follows: cΔCVP-derived ΔPpl = k × ΔCVP, where k was the ratio of the change in airway pressure (ΔPaw) to the ΔCVP during airway occlusion test. Results Of the 14 patients enrolled in the study, 6 were excluded because correct positioning of the esophageal balloon could not be confirmed, leaving eight patients for analysis (mean age, 4.8 months). Three variables that reflected ΔPpl (ΔPes, ΔCVP, and cΔCVP-derived ΔPpl) were measured and yielded the following results: -6.7 ± 4.8, − -2.6 ± 1.4, and − -7.3 ± 4.5 cmH2O, respectively. The repeated measures correlation between cΔCVP-derived ΔPpl and ΔPes showed that cΔCVP-derived ΔPpl had good correlation with ΔPes (r = 0.84, p< 0.0001). Conclusions ΔPpl can be estimated reasonably accurately by ΔCVP using our method in assisted and unassisted spontaneous breathing children during mechanical ventilation.

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Detection of strong inspiratory efforts from the analysis of central venous pressure swings: a preliminary clinical study

Cited by 14 publications

References 40 publications

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

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

Pulmonary air leak in COVID-19: time to learn from our mistakes

Estimation of change in pleural pressure in assisted and unassisted spontaneous breathing pediatric patients using fluctuation of central venous pressure: A preliminary study

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