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Esophageal and Transpulmonary Pressure Different results? Laurent Brochard Toronto
Esophageal and TranspulmonaryPressure
Different results?
Laurent Brochard
Toronto
Conflicts of interest
• Our clinical research laboratory has received research grantsor equipment for clinical research projects from the followingcompanies: – Maquet (NAVA)
– Covidien (PAV+)
– General Electric (FRC, ultrasound)
– Philips (sleep)
– Fisher Paykel (Optiflow)
– Air Liquide (Helium, CPR)
Esophageal pressure monitoring
• Technical aspects
• plug_video_V3_422intero.mp4
From Mojoli et al. 2014
Pes during passive ventilation and measurements
Esophageal Pressure Waveform
Ventilator Waveform
Pes during spontaneous breathing
-1
-0,5
0
0,5
1
1,5
Flow
(L/s
)
-2,5
-2
-1,5
-1
-0,5
0
0 3 6 9 12
seconds (s)
Pes
(cm
H 2O
)0
5
10
15
20
Paw
(cm
H2O
)
-5
-20
Monitoring underPartial Assist
• PS 15/5 cmH2O
• Vt ≈ 600 ML
• Delta Peso 15 cmH20
• High Delta Ptp = risk (?) of VILI
• Negative pressure =
High LV afterload
Mauri T, and the PLUG. ICM 2016
Mojoli F et al Minerva Anesth 2016
Mojoli F et al Crit Care 2016
Mojoli F et al Crit Care 2016
Supine
Esophageal and directly measured pleural pressure: a validation study on Thiel cadavers
• D L Grieco, …JC M Richard, L Brochard and the laboratory of Trois Rivieres (Quebec)
• Pleural pressure was directly measured in a non-dependent zone (sternal) and in a dependent zone (vertebral) and compared to Pes
• Measurements were repeated prone
E n d e x p ir a to r y a b s o lu te v a lu e s
M e a n a n d S D d is p la y e d
P e e p
cm
H2
O
0 5 1 0 1 5 2 0 2 5
0
5
1 0
1 5
2 0
2 5
3 0
O e s o p h a g e l p re s s u re
n o n d e p e n d e n t p le u ra l p re s s
d e p e n d e n t p le u ra l p re s s u re
E n d in s p ir a to r y a b s o lu te v a lu e s
M e a n a n d S D d is p la y e d
P e e p
0 5 1 0 1 5 2 0
0
5
1 0
1 5
2 0
2 5
3 0
3 5
4 0
O e s o p h a g e l p re s su re
n o n d e p e n d e n t p le u ra l p re ss
d e p e n d e n t p le u ra l p re ssu re
AJRCCM 2016 on line
From Chen L.
Transpulmonary pressure: why use it?
• Influence of the chest wall
• Amplitude of Ptp and risk of VILI (stress)
• Setting of PEEP
• Patient-ventilator synchrony
• Weaning and effort
• …More?
Mauri T, and the PLUG. ICM 2016
