Measurement of pleural pressure swings with a fluid-filled esophageal catheter vs pulmonary artery occlusion pressure

Verscheure, Sara; Massion, Paul; Gottfried, S. B.; Goldberg, Peter; Samy, Laïla; Damas, Pierre; Magder, Sheldon

doi:10.1016/j.jcrc.2016.08.024

Cited by 16 publications

(18 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As an example of this, we previously showed that the peak change in pulmonary artery occlusion pressure during a spontaneous inspiratory effort closely matches the fall in esophageal pressure, and thus can track inspiratory efforts relative to atmosphere (28,29). However, the fall in pulmonary artery occlusions pressure was on average 2 mmHg less than the fall in esophageal pressure because of the inspiratory increase in left heart filling.…”

Section: Right Ventricular Outflowmentioning

confidence: 80%

“…Expiration normally is passive and CVP does not change during expiration. However, abdominal muscles can be activated during expiration and increase abdominal pressure (29,30). This can increase the return of blood to the right heart from the abdominal compartment and produce an Ann Transl Med 2018;6(18):348 atm.amegroups.com expiratory component to right heart filling.…”

Section: Abdominal Componentmentioning

confidence: 99%

See 1 more Smart Citation

Heart-Lung interaction in spontaneous breathing subjects: the basics

Magder¹

2018

Ann. Transl. Med.

View full text Add to dashboard Cite

Heart-lung interactions occur primarily because of two components of lung inflation, changes in pleural pressure and changes in transpulmonary pressure. Of these, changes in pleural pressure dominate during spontaneous breathing. Because the heart is surrounded by pleural pressure, during inspiration the environment of the heart falls relative to the rest of the body. This alters inflow into the right heart and outflow from the left heart. Alterations in transpulmonary pressure can alter the outflow from the right heart and the inflow to the left heart. These interactions are modified by the cardiac and respiratory frequency, ventricular function and magnitude of the respiratory efforts.

show abstract

Section: Right Ventricular Outflowmentioning

confidence: 80%

Section: Abdominal Componentmentioning

confidence: 99%

Heart-Lung interaction in spontaneous breathing subjects: the basics

Magder¹

2018

Ann. Transl. Med.

View full text Add to dashboard Cite

show abstract

“…Strong respiratory efforts resulting in negative pleural pressure swings have an important effect on CVP values. These interferences could have been captured by an esophageal balloon [29,30], but as this was a pragmatic and observational study, we did not include this measurement in the protocol. However, the CVP-test was assessed only 2 minutes after discontinuing positive pressure ventilation and therefore it is unlikely that this factor could have influenced CVP values in a clinically relevant fashion.…”

Section: Discussionmentioning

confidence: 99%

Early rise in central venous pressure during a spontaneous breathing trial: A promising test to identify patients at high risk of weaning failure?

et al. 2019

View full text Add to dashboard Cite

BackgroundThe spontaneous breathing trial (SBT) assesses the risk of weaning failure by evaluating some physiological responses to the massive venous return increase imposed by discontinuing positive pressure ventilation. This trial can be very demanding for some critically ill patients, inducing excessive physical and cardiovascular stress, including muscle fatigue, heart ischemia and eventually cardiac dysfunction. Extubation failure with emergency reintubation is a serious adverse consequence of a failed weaning process. Some data suggest that as many as 50% of patients that fail weaning do so because of cardiac dysfunction. Unfortunately, monitoring cardiovascular function at the time of the SBT is complex. The aim of our study was to explore if central venous pressure (CVP) changes were related to weaning failure after starting an SBT. We hypothesized that an early rise on CVP could signal a cardiac failure when handling a massive increase on venous return following a discontinuation of positive pressure ventilation. This CVP rise could identify a subset of patients at high risk for extubation failure.MethodsTwo-hundred and four mechanically ventilated patients in whom an SBT was decided were subjected to a monitoring protocol that included blinded assessment of CVP at baseline, and at 2 minutes after starting the trial (CVP-test). Weaning failure was defined as reintubation within 48-hours following extubation. Comparisons between two parametric or non-parametric variables were performed with student T test or Mann Whitney U test, respectively. A logistic multivariate regression was performed to determine the predictive value on extubation failure of usual clinical variables and CVP at 2-min after starting the SBT.ResultsOne-hundred and sixty-five patients were extubated after the SBT, 11 of whom were reintubated within 48h. Absolute CVP values at 2-minutes, and the change from baseline (dCVP) were significantly higher in patients with extubation failure as compared to those successfully weaned. dCVP was an early predictor for reintubation (OR: 1.70 [1.31,2.19], p<0.001).ConclusionsAn early rise in CVP after starting an SBT was associated with an increased risk of extubation failure. This might represent a warning signal not captured by usual SBT monitoring and could have relevant clinical implications.

show abstract

“…In addition, displacement of the diaphragm was consistently less during anesthesia paralysis and mechanical ventilation than during SB. Furthermore, CMV may increase the pleural pressure and therefore the pressure to adjacent cardiac structures, i.e., the phrenic nerve and/or the target region for LV lead placement . All these effects may reverse after cessation of general anesthesia and therefore alter the findings of intraoperative FLP compared to postoperative FLP.…”

Section: Discussionmentioning

confidence: 99%