Two Steps Forward in Bedside Monitoring of Lung Mechanics: Transpulmonary Pressure and Lung Volume

Cortes, Gustavo; Marini, John J.

doi:10.1007/978-3-642-35109-9_36

Cited by 5 publications

(5 citation statements)

References 39 publications

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“…In fact, the main focus of the physician is the mechanical behavior of the passive lungs, while Paw-based interpretations of respiratory mechanics are often influenced by several pathophysiological alterations: differences in breathing pattern, altered chest wall characteristics (often secondary to fluid overload) (9), alterations in lung volume, increased intra-abdominal pressure (IAP) (such as with capillary leak or fluid overload) (10), the extent of lung edema and collapse, the distribution and asymmetry of lung disease (11), the presence and extent of spontaneous breathing efforts (12). It has been shown how all of these factors do complicate the interpretation of respiratory mechanics, thus preventing the interpretation of Paw to be easily generalizable (13).…”

Section: Limits Of Paw Monitoringmentioning

confidence: 99%

Interpretation of the transpulmonary pressure in the critically ill patient

Umbrello

Chiumello²

2018

Ann. Transl. Med

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Mechanical ventilation is a life-saving procedure, which takes over the function of the respiratory muscles while buying time for healing to take place. However, it can also promote or worsen lung injury, so that careful monitoring of respiratory mechanics is suggested to titrate the level of support and avoid injurious pressures and volumes to develop. Standard monitoring includes flow, volume and airway pressure (Paw). However, Paw represents the pressure acting on the respiratory system as a whole, and does not allow to differentiate the part of pressure that is spent di distend the chest wall. Moreover, if spontaneous breathing efforts are allowed, the Paw is the sum of that applied by the ventilator and that generated by the patient. As a consequence, monitoring of Paw has significant shortcomings. Assessment of esophageal pressure (Pes), as a surrogate for pleural pressure (Ppl), may allow the clinicians to discriminate between the elastic behaviour of the lung and the chest wall, and to calculate the degree of spontaneous respiratory effort. In the present review, the characteristics and limitations of airway and transpulmonary pressure monitoring will be presented; we will highlight the different assumptions underlying the various methods for measuring transpulmonary pressure (i.e., the elastance-derived and the release-derived method, and the direct measurement), as well as the potential application of transpulmonary pressure assessment during both controlled and spontaneous/assisted mechanical ventilation in critically ill patients.

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Section: Limits Of Paw Monitoringmentioning

confidence: 99%

Interpretation of the transpulmonary pressure in the critically ill patient

Umbrello

Chiumello²

2018

Ann. Transl. Med

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“…Fourth, standard monitoring (eg, tracheal pressure and flow) cannot detect pendelluft; therefore, additional monitoring is important, such as electrical impedance tomography 15 as well as measurements of the strength of spontaneous effort (eg, esophageal manometry, electromyography, ultrasound) 11 and transpulmonary driving pressure (⌬P tp ϭ P tp insp Ϫ P tp exp ). 16…”

Section: Spontaneous Breathing During Mechanical Ventilation: Not Always Goodmentioning

confidence: 99%

2016 Year in Review: Mechanical Ventilation

Pettenuzzo

Fan

2017

Respir Care

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“…Selection of appropriate PEEP levels based on pressure-volume curve analysis or a patient's oxygenation level has been advocated, but uncertainties remain with regard to the best way to determine the optimum PEEP level (Miller et al, 2012;Schmidt, 2012;Soni and Williams, 2008). FRC measurement to guide PEEP levels has been advocated for some time, but has not been used in routine clinical practice (Cortes and Marini, 2013;Hedenstierna, 1993;Rouby et al, 2013). Early methods relied on mass spectrometers (Gothard et al, 1980;Mitchell et al, 1982;Sivan et al, 1990;Williams et al, 1997), but they are bulky, temperamental and becoming harder to source (Arieli, 2010;Hahn, 1996;Horsley et al, 2014), so have not been used in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Modelling mixing within the dead space of the lung improves predictions of functional residual capacity

Harrison

Phan

Zhang

et al. 2017

Respiratory Physiology & Neurobiology

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Routine estimation of functional residual capacity (FRC) in ventilated patients has been a long held goal, with many methods previously proposed, but none have been used in routine clinical practice. This paper proposes three models for determining FRC using the nitrous oxide concentration from the entire expired breath in order to improve the precision of the estimate. Of the three models proposed, a dead space with two mixing compartments provided the best results, reducing the mean limits of agreement with the FRC measured by whole body plethysmography by up to 41%. This moves away from traditional lung models, which do not account for mixing within the dead space. Compared to literature values for FRC, the results are similar to those obtained using helium dilution and better than the LUFU device (Dräger Medical, Lubeck, Germany), with significantly better limits of agreement compared to plethysmography.

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Two Steps Forward in Bedside Monitoring of Lung Mechanics: Transpulmonary Pressure and Lung Volume

Cited by 5 publications

References 39 publications

Interpretation of the transpulmonary pressure in the critically ill patient

Interpretation of the transpulmonary pressure in the critically ill patient

2016 Year in Review: Mechanical Ventilation

Modelling mixing within the dead space of the lung improves predictions of functional residual capacity

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