Oesophageal balloon calibration during pressure support ventilation: a proof of concept study

Cammarota, Gianmaria; Verdina, Federico; Santangelo, Erminio; Lauro, Gianluigi; Boniolo, Ester; Tarquini, Riccardo; Spinelli, Elena; Zanoni, Marta; Garofalo, Eugenio; Bruni, Andrea; Artigas, Antonio; Corte, Francesco Della; Navalesi, Paolo; Vaschetto, Rosanna; Mauri, Tommaso

doi:10.1007/s10877-019-00436-3

Cited by 6 publications

(9 citation statements)

References 27 publications

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“…The research was performed with only one Mindray esophageal balloon catheter. Although our research and previous studies have confirmed the reliability of the method ( 9 , 11 , 15 ), whether the results can be directly generalized to other esophageal catheters and other patient populations is still in question. The sample size of this study was small, and one patient underwent up to five tests, which may be a factor that led to the overall higher esophageal pressure values in this study than in other studies ( 9 , 11 ).…”

Section: Limitations Of the Studymentioning

confidence: 48%

“…Sun et al enrolled 40 patients under passive ventilation and verified the reliability of the method on a Cooper balloon catheter (geometric volume of 2.8 ml) ( 11 ). The method of calibrating Pes values was verified again during pressure support ventilation ( 15 ). Compared with the in vitro study, V BEST was significantly increased in the in vivo test, suggesting that the pressure of the esophageal wall may have an effect on it.…”

Section: Discussionmentioning

confidence: 99%

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The calibration of esophageal pressure by proper esophageal balloon filling volume: A clinical study

Jiang

Su²,

Cheng³

et al. 2022

Front. Med.

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BackgroundEsophageal pressure (Pes) can be used as a reliable surrogate for pleural pressure, especially in critically ill patients requiring personalized mechanical ventilation strategies. How to choose the proper esophageal balloon filling volume and then find the optimal value of esophageal pressure remains a challenge. The study aimed to assess the feasibility of catheters for Pes monitoring in mechanically ventilated patients.Materials and methodsTwelve patients under pressure-controlled mechanical ventilation were included in this study. Raw esophageal pressure was recorded at different balloon filling volumes. Then, the P-V curves were determined. VWORK was the intermediate linear section on the end-expiratory P-V curve, and VBEST was the filling volume providing the maximum difference between Pes at end-inspiration and end-expiration. The raw value of Pes was recorded, and the calibrated values of Pes were calculated by calculating the esophageal wall pressure (Pew) and esophageal elastance (Ees).ResultsTwenty-four series of Pes measurements were performed. The mean VMIN and VMAX were 2.17 ± 0.49 ml (range, 1.0–3.0 ml) and 6.79 ± 0.83 ml (range, 5.0–9.0 ml), respectively, whereas VBEST was 4.69 ± 0.16 ml (range, 2.0–8.0 ml). Ees was 1.35 ± 0.51 cm H2O/ml (range, 0.26–2.38 cm H2O/ml). The estimated Pew at VBEST was 3.16 ± 2.19 cm H2O (range, 0–7.97 cm H2O). Patients with a body mass index (BMI) ≥ 25 kg/m2 had a significantly lower VMAX (5.88 [5.25–6] vs. 7.25 [7–8] ml, p = 0.006) and a significantly lower VBEST (3.69 [2.5–4.38] vs. 5.19 [4–6] ml, p = 0.036) than patients with a BMI < 25 kg/m2. Patients with positive end-expiratory pressure (PEEP) ≥ 10 cm H2O had a lower VMIN and VBEST than patients with PEEP < 10 cm H2O, P > 0.05. Patients in the supine position had a higher esophageal pressure than those in the prone position with the same balloon filling volume.ConclusionsCalibration of esophageal pressure to identify the best filling volume of esophageal balloon catheters is feasible. The esophageal pressure can be influenced by BMI, PEEP, and position. It is necessary to titrate the optimal inflation volume again when the PEEP values or the positions change.

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Section: Limitations Of the Studymentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

The calibration of esophageal pressure by proper esophageal balloon filling volume: A clinical study

Jiang

Su²,

Cheng³

et al. 2022

Front. Med.

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“…[24][25][26][27] By insufflating the esophageal balloon with the optimal filling volume, a validation occlusion test has been demonstrated to be passed a posteriori in a higher percentage of cases compared to uncalibrated volume, with which the test was passed in 57% and 52% of the cases in passive and active conditions. 26 Recent findings support the validity of esophageal manometry, provided a proper calibration of the esophageal balloon is assured. 6 In experimental conditions of lung-injured pigs and human cadavers subjected to direct pleural and esophageal pressure monitoring in the supine position, 6 the vertical gradient of pleural pressure was confirmed.…”

Section: Scan For Cme Exammentioning

confidence: 99%

“…23 To correct the artifacts related to esophageal wall contraction in response to balloon inflation and balloon elastic recoil, an ad hoc procedure of balloon calibration has been proposed in both invasive controlled mechanical ventilation and assisted breathing. 24–27 This procedure relies on the identification of the optimal esophageal balloon filling volume able to optimize the transmission of the esophageal pressure tidal swings, and removal of the artifacts responsible for an incorrect increase in esophageal pressure above the pleural pressure, i.e. , esophageal wall and balloon elastance, respectively.…”

Section: Esophageal Pressurementioning

confidence: 99%

Advanced Point-of-care Bedside Monitoring for Acute Respiratory Failure

et al. 2023

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Advanced respiratory monitoring involves several mini- or noninvasive tools, applicable at bedside, focused on assessing lung aeration and morphology, lung recruitment and overdistention, ventilation–perfusion distribution, inspiratory effort, respiratory drive, respiratory muscle contraction, and patient–ventilator asynchrony, in dealing with acute respiratory failure. Compared to a conventional approach, advanced respiratory monitoring has the potential to provide more insights into the pathologic modifications of lung aeration induced by the underlying disease, follow the response to therapies, and support clinicians in setting up a respiratory support strategy aimed at protecting the lung and respiratory muscles. Thus, in the clinical management of the acute respiratory failure, advanced respiratory monitoring could play a key role when a therapeutic strategy, relying on individualization of the treatments, is adopted.

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“…Patients enrollment was interrupted from the end of February to May 2020 because of the disease due to novel coronavirus'19 outbreak and subsequently resumed in June of the same year [28]. PSV setting at baseline was the same as that observed at patients' enrollment, with a combination of PEEP, inspired oxygen fraction, and inspiratory pressure support over PEEP set, according to our routine clinical practice, to preserve pH and arterial carbon dioxide tension within a physiologic range and to maintain a peripheral oxygen saturation between 92 and 96% [29][30][31]. However, setting PSV at baseline as in our case might put patients at risk for lung overdistention when the threshold of 8 ml kg −1 is exceeded during assisted breath.…”

Section: Discussionmentioning

confidence: 99%

Effects of Varying Levels of Inspiratory Assistance with Pressure Support Ventilation and Neurally Adjusted Ventilatory Assist on Driving Pressure in Patients Recovering from Hypoxemic Respiratory Failure

Cammarota

Verdina

Vita

et al. 2021

J Clin Monit Comput

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Background Driving pressure can be readily measured during assisted modes of ventilation such as pressure support ventilation (PSV) and neurally adjusted ventilatory assist (NAVA). The present prospective randomized crossover study aimed to assess the changes in driving pressure in response to variations in the level of assistance delivered by PSV vs NAVA. Methods 16 intubated adult patients, recovering from hypoxemic acute respiratory failure (ARF) and undergoing assisted ventilation, were randomly subjected to six 30-min-lasting trials. At baseline, PSV (PSV100) was set with the same regulation present at patient enrollment. The corresponding level of NAVA (NAVA100) was set to match the same inspiratory peak of airway pressure obtained in PSV100. Therefore, the level of assistance was reduced and increased by 50% in both ventilatory modes (PSV50, NAVA50; PSV150, NAVA150). At the end of each trial, driving pressure obtained in response to four short (2-3 s) end-expiratory and end-inspiratory occlusions was analyzed. Results Driving pressure at PSV50 (6.6 [6.1-7.8] cmH 2 O) was lower than that recorded at PSV100 (7.9 [7.2-9.1] cmH 2 O, P = 0.005) and PSV150 (9.9 [9.1-13.2] cmH 2 O, P < 0.0001). In NAVA, driving pressure at NAVA50 was reduced compared to NAVA150 (7.7 [5.1-8.1] cmH 2 O vs 8.3 [6.4-11.4] cmH 2 O, P = 0.013), whereas there were no changes between baseline and NAVA150 (8.5 [6.3-9.8] cmH 2 O vs 8.3 [6.4-11.4] cmH 2 O, P = 0.331, respectively). Driving pressure at PSV150 was higher than that observed in NAVA150 (P = 0.011). Conclusions NAVA delivers better lung-protective ventilation compared to PSV in hypoxemic ARF patients. Trial registration number and date of registration The present trial was prospectively registered at www.clini catri als.gov (NCT03719365) on

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Oesophageal balloon calibration during pressure support ventilation: a proof of concept study

Cited by 6 publications

References 27 publications

The calibration of esophageal pressure by proper esophageal balloon filling volume: A clinical study

The calibration of esophageal pressure by proper esophageal balloon filling volume: A clinical study

Advanced Point-of-care Bedside Monitoring for Acute Respiratory Failure

Effects of Varying Levels of Inspiratory Assistance with Pressure Support Ventilation and Neurally Adjusted Ventilatory Assist on Driving Pressure in Patients Recovering from Hypoxemic Respiratory Failure

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