Tommaso Mauri1, Takeshi Yoshida2,3,4, Giacomo Bellani5, Ewan C Goligher6,7,8, Guillaume Carteaux9,10, Nuttapol Rittayamai11,12,8, Francesco Mojoli13, Davide Chiumello1,14, Lise Piquilloud15,16, Salvatore Grasso17, Amal Jubran18, Franco Laghi18, Sheldon Magder19, Antonio Pesenti1,14, Stephen Loring20, Luciano Gattinoni1,14, Daniel Talmor20, Lluis Blanch21, Marcelo Amato22, Lu Chen12,8, Laurent Brochard23,24, Jordi Mancebo25. 1. Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 2. Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. 3. Intensive Care Unit, Osaka University Hospital, Suita, Japan. 4. Department of Anesthesia, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. 5. Department of Health Science, University of Milan-Bicocca, Monza, MB, Italy. 6. Department of Physiology, University of Toronto, Toronto, Canada. 7. Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada. 8. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 9. DHU A-TVB, Service de Réanimation Médicale, CHU Henri Mondor, Assistance Publique-Hôpitaux de Paris, , Créteil, France. 10. Groupe de recherche clinique CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, Créteil, France. 11. Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand. 12. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. 13. Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy. 14. Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy. 15. Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland. 16. Department of Medical Intensive Care, University Hospital of Angers, Angers, France. 17. Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari "Aldo Moro", Bari, Italy. 18. Division of Pulmonary and Critical Care Medicine, Edward Hines Jr., Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL, USA. 19. Department of Critical Care, McGill University Heath Centre, Glen Site Campus, Montreal, QC, Canada. 20. Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. 21. Institut de Investigació i Innovació Parc Taulí, CIBER Enfermedades Respiratorias, Critical Care Center, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain. 22. Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo, São Paulo, Brazil. 23. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. BrochardL@smh.ca. 24. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. BrochardL@smh.ca. 25. Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain.
Abstract
PURPOSE: Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. METHODS: This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. RESULTS: After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning. Moreover, Pes monitoring permits accurate measurement of transmural vascular pressure and intrinsic positive end-expiratory pressure and facilitates detection of patient-ventilator asynchrony, thereby supporting specific diagnoses and interventions. Finally, some Pes-derived measures may also be obtained by monitoring electrical activity of the diaphragm. CONCLUSIONS: Pes monitoring provides unique bedside measures for a better understanding of the pathophysiology of acute respiratory failure patients. Including Pes monitoring in the intensivist's clinical armamentarium may enhance treatment to improve clinical outcomes.
PURPOSE: Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failurepatients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only. METHODS: This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes. RESULTS: After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning. Moreover, Pes monitoring permits accurate measurement of transmural vascular pressure and intrinsic positive end-expiratory pressure and facilitates detection of patient-ventilator asynchrony, thereby supporting specific diagnoses and interventions. Finally, some Pes-derived measures may also be obtained by monitoring electrical activity of the diaphragm. CONCLUSIONS: Pes monitoring provides unique bedside measures for a better understanding of the pathophysiology of acute respiratory failurepatients. Including Pes monitoring in the intensivist's clinical armamentarium may enhance treatment to improve clinical outcomes.
Authors: F Mojoli; D Chiumello; M Pozzi; I Algieri; S Bianzina; S Luoni; C A Volta; A Braschi; L Brochard Journal: Minerva Anestesiol Date: 2015-01-30 Impact factor: 3.051
Authors: Lluís Blanch; Ana Villagra; Bernat Sales; Jaume Montanya; Umberto Lucangelo; Manel Luján; Oscar García-Esquirol; Encarna Chacón; Anna Estruga; Joan C Oliva; Alberto Hernández-Abadia; Guillermo M Albaiceta; Enrique Fernández-Mondejar; Rafael Fernández; Josefina Lopez-Aguilar; Jesús Villar; Gastón Murias; Robert M Kacmarek Journal: Intensive Care Med Date: 2015-02-19 Impact factor: 17.440
Authors: Davide Colombo; Gianmaria Cammarota; Moreno Alemani; Luca Carenzo; Federico Lorenzo Barra; Rosanna Vaschetto; Arthur S Slutsky; Francesco Della Corte; Paolo Navalesi Journal: Crit Care Med Date: 2011-11 Impact factor: 7.598
Authors: Ewan C Goligher; Eddy Fan; Margaret S Herridge; Alistair Murray; Stefannie Vorona; Debbie Brace; Nuttapol Rittayamai; Ashley Lanys; George Tomlinson; Jeffrey M Singh; Steffen-Sebastian Bolz; Gordon D Rubenfeld; Brian P Kavanagh; Laurent J Brochard; Niall D Ferguson Journal: Am J Respir Crit Care Med Date: 2015-11-01 Impact factor: 21.405
Authors: Pierpaolo Terragni; Luciana Mascia; Vito Fanelli; Giuseppe Biondi-Zoccai; V Marco Ranieri Journal: Intensive Care Med Date: 2016-10-15 Impact factor: 17.440
Authors: Tommaso Mauri; Thomas Langer; Alberto Zanella; Giacomo Grasselli; Antonio Pesenti Journal: Intensive Care Med Date: 2016-08-11 Impact factor: 17.440