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Setting positive end-expiratory pressure: the use of esophageal pressure measurements.
Curr Opin Crit Care
February 2024
Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
Purpose Of Review: To summarize the key concepts, physiological rationale and clinical evidence for titrating positive end-expiratory pressure (PEEP) using transpulmonary pressure ( PL ) derived from esophageal manometry, and describe considerations to facilitate bedside implementation.
Recent Findings: The goal of an esophageal pressure-based PEEP setting is to have sufficient PL at end-expiration to keep (part of) the lung open at the end of expiration. Although randomized studies (EPVent-1 and EPVent-2) have not yet proven a clinical benefit of this approach, a recent posthoc analysis of EPVent-2 revealed a potential benefit in patients with lower APACHE II score and when PEEP setting resulted in end-expiratory PL values close to 0 ± 2 cmH 2 O instead of higher or more negative values.
Definition and clinical evaluation of a recruiting airway pressure based on the specific lung elastance in anesthetized dogs.
Vet Anaesth Analg
July 2021
Section of Veterinary Clinics and Animal Production, Department of Emergency and Organ Transplantation D.E.O.T., "Aldo Moro" University of Bari, Bari, Italy.
Objective: To determine the specific lung elastance (SE) in anesthetized dogs and to evaluate the efficacy of a SE-based recruiting airway pressure (RP) at improving global and regional lung aeration.
Study Design: Retrospective and prospective clinical study.
Animals: A total of 28 adult dogs were included in the retrospective study and six adult dogs in the prospective study.
Personalized Positive End-Expiratory Pressure in Acute Respiratory Distress Syndrome: Comparison Between Optimal Distribution of Regional Ventilation and Positive Transpulmonary Pressure.
Crit Care Med
August 2020
Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Objectives: Different techniques exist to select personalized positive end-expiratory pressure in patients affected by the acute respiratory distress syndrome. The positive end-expiratory transpulmonary pressure strategy aims to counteract dorsal lung collapse, whereas electrical impedance tomography could guide positive end-expiratory pressure selection based on optimal homogeneity of ventilation distribution. We compared the physiologic effects of positive end-expiratory pressure guided by electrical impedance tomography versus transpulmonary pressure in patients affected by acute respiratory distress syndrome.
View Article and Find Full Text PDFTranspulmonary thermodilution monitoring-guided hemodynamic management improves cognitive function in patients with aneurysmal subarachnoid hemorrhage: a prospective cohort comparison.
Acta Neurochir (Wien)
July 2019
Department of Anesthesiology and Reanimation, Istanbul University, Istanbul Medical Faculty, Turgut Ozal cad. Fatih, Istanbul, Turkey.
Background: The effects of goal-directed hemodynamic management using transpulmonary thermodilution (TPT) monitor on the cognitive function of patients with aneurysmal subarachnoid hemorrhage (aSAH) remain unclear. The present study aimed to determine whether hemodynamic management with TPT monitor provides better cognitive function compared with standard hemodynamic management.
Methods: Patients with aSAH who were admitted to the intensive care unit in 2016 were assigned to cohort 1, and those admitted in 2017 were assigned to cohort 2.
Should we titrate positive end-expiratory pressure based on an end-expiratory transpulmonary pressure?
Ann Transl Med
October 2018
Department of Pulmonary and Critical Care Medicine, University of Minnesota, Minneapolis, MN, USA.
Arguments continue to swirl regarding the need for and best method of positive end-expiratory pressure (PEEP) titration. An appropriately conducted decremental method that uses modest peak pressures for the recruiting maneuver (RM), a lung protective tidal excursion, relatively small PEEP increments and appropriate timing intervals is currently the most logical and attractive option, particularly when the esophageal balloon pressure (Pes) is used to calculate transpulmonary driving pressures relevant to the lung. The setting of PEEP by the Pes-guided end-expiratory pressure at the 'polarity transition' point of the transmural end-expiratory pressure is quite relevant to the locale of the esophageal balloon catheter.
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