The Correlation Between Esophageal and Abdominal Pressures in Mechanically Ventilated Patients Undergoing Laparoscopic Surgery

Sindi, Anees; Piraino, Tom; Alhazzani, Waleed; Tunks, Marcel; Faden, Mazen; Thabane, Lehana; Meade, Maureen O.

doi:10.4187/respcare.02287

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…volume. Sindi et al 23 evaluated the correlation between esophageal and abdominal pressures in mechanically ventilated subjects undergoing laparoscopic surgery. In those subjects without respiratory disease, there was a significant but limited relationship between esophageal and abdominal pressures.…”

Section: Intra-abdominal Pressurementioning

confidence: 99%

Respiratory Mechanics in Mechanically Ventilated Patients

2014

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Respiratory mechanics refers to the expression of lung function through measures of pressure and flow. From these measurements, a variety of derived indices can be determined, such as volume, compliance, resistance, and work of breathing. Plateau pressure is a measure of end-inspiratory distending pressure. It has become increasingly appreciated that end-inspiratory transpulmonary pressure (stress) might be a better indicator of the potential for lung injury than plateau pressure alone. This has resulted in a resurgence of interest in the use of esophageal manometry in mechanically ventilated patients. End-expiratory transpulmonary pressure might also be useful to guide the RESPIRATORY CARE • NOVEMBER 2014 VOL 59 NO 11 1773 setting of PEEP to counterbalance the collapsing effects of the chest wall. The shape of the pressuretime curve might also be useful to guide the setting of PEEP (stress index). This has focused interest in the roles of stress and strain to assess the potential for lung injury during mechanical ventilation. This paper covers both basic and advanced respiratory mechanics during mechanical ventilation.

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Section: Intra-abdominal Pressurementioning

confidence: 99%

Respiratory Mechanics in Mechanically Ventilated Patients

2014

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“…Secondly, associations of intrabdominal pressure and the intrathoracic pressure is a controversial determinant for post operatory pulmonary complications. Nevertheless some studies 4 did not reported an straight relation between the raise on the intrabdominal pressure and the intrathoracic pressure on patients undergoing laparoscopy surgery. On the other hand, there are also the severe pathophysiological effects occurring not only on the lung, but also on the liver, kidney and heart, which potentially lead to cardiorenal, hepatopulmonary or hepatorenal syndromes.…”

mentioning

confidence: 98%

Systemic stress and PEEP relationships during laparoscopic cholecystectomy: a new protective marker?

Blanco

Esquinas

2018

Brazilian Journal of Anesthesiology (English Edition)

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“…4 This is obviously true, considering the characteristics of their sample. However, in the end, the correlation found opens a new track to future investigations on the adjustment and monitoring of the ideal PEEP level.…”

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confidence: 99%

“…The strategy used to set it properly can vary from one center to another, always depending on the ICU's economic condition and the professionals' skills. [1][2][3] In this issue of RESPIRATORY CARE, the study by Sindi et al 4 contributes to the knowledge of respiratory mechanics and, furthermore, carries a very important message to the ICU health care professional. The authors studied surgical patients who underwent laparoscopy, exploring the correlation between abdominal pressure (P abd ) and esophageal pressure (P es ).…”

mentioning

confidence: 99%

“…This is also looking forward. Sindi et al 4 understood that, as explained by Sarge and Talmor, 8 the airway pressure itself will fail to separate severe perturbations in the elastance of the respiratory system when we titrate the PEEP level, and that is why their results are important: the health care professional must have alternative or complementary measurements to achieve this important goal.…”

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confidence: 99%

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Looking Around to Look Forward

Corbellini

2014

Respir Care

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Monitoring should be an obsession in the management of mechanically ventilated patients. The control of vital signs and respiratory parameters must guide the ICU professional in responding with precision to the patient's needs. The setting of mechanical ventilation parameters is a very important issue in the management of a critically ill patient, and the setting of the ideal PEEP level is a particular chapter that has been largely investigated and is still challenging. The strategy used to set it properly can vary from one center to another, always depending on the ICU's economic condition and the professionals' skills. [1][2][3] In this issue of RESPIRATORY CARE, the study by Sindi et al 4 contributes to the knowledge of respiratory mechanics and, furthermore, carries a very important message to the ICU health care professional. The authors studied surgical patients who underwent laparoscopy, exploring the correlation between abdominal pressure (P abd ) and esophageal pressure (P es ). As P es is an alternative for estimation of pleural pressure (P pl ), the correlation of P abd with P es should be useful to obtain information on P pl bypassing the measurement of P es in these patients. The measurement of P es and P pl to set the PEEP has already been proposed. [5][6][7] Unlike other trials, the protocol proposed by Sindi et al measured P abd in patients with neuromuscular blockade, which eliminates the effect of the diaphragmatic tone and allows a more reliable estimation of P pl . Their results show us that P abd may provide useful complementary information in the management of mechanically ventilated patients.Beyond the main goal, there is a hidden objective, which is stated in the last paragraph of the introduction, that I want to address: "stimulate researchers to look at the use of bedside abdominal pressure measurements." Why is this important? The study by Sindi et al 4 encourages us to look around and to give value to all bedside information available when the patient is mechanically ventilated. Looking forward, Sindi et al show us that, at least in some clinical settings, the assessment of P abd by bladder pressure measurement could be helpful to estimate P pl to set the PEEP level safely, avoiding the potential problems and risks of esophageal probe insertion and proposing a solution to the problem of a lack of familiarity with this technique. This is a dilemma of P es and P abd monitoring. The interpretation of information regarding the measurement of P es and P abd must be analyzed carefully. If we ignore P abd , for example, we could also ignore its effect on P pl and its implications in the management of mechanically ventilated patients. 7 Regarding the field of monitoring ICU patients, the authors make a very important point: different instruments and parameters may be considered for deciding the setting of mechanical ventilation. Any parameter that is just in front of us must not be denied or underestimated. Relevant information may be easy to find if we take a careful look around.The authors ...

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The Correlation Between Esophageal and Abdominal Pressures in Mechanically Ventilated Patients Undergoing Laparoscopic Surgery

Cited by 8 publications

References 17 publications

Respiratory Mechanics in Mechanically Ventilated Patients

Respiratory Mechanics in Mechanically Ventilated Patients

Systemic stress and PEEP relationships during laparoscopic cholecystectomy: a new protective marker?

Looking Around to Look Forward

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