Document Detail

Are esophageal pressure measurements important in clinical decision-making in mechanically ventilated patients?
MedLine Citation:
PMID:  20105342     Owner:  NLM     Status:  MEDLINE    
Low-tidal-volume ventilation strategies are clearly beneficial in patients with acute lung injury and acute respiratory distress syndrome, but the optimal level of applied positive end-expiratory pressure (PEEP) is uncertain. In patients with high pleural pressure on conventional ventilator settings, under-inflation may lead to atelectasis, hypoxemia, and exacerbation of lung injury through "atelectrauma." In such patients, raising PEEP to maintain a positive transpulmonary pressure might improve aeration and oxygenation without causing over-distention. Conversely, in patients with low pleural pressure, maintaining a low PEEP would keep transpulmonary pressure low, avoiding over-distention and consequent "volutrauma." Thus, the currently recommended strategy of setting PEEP without regard to transpulmonary pressure is predicted to benefit some patients while harming others. Recently the use of esophageal manometry to identify the optimal ventilator settings, avoiding both under-inflation and over-inflation, was proposed. This method shows promise but awaits larger clinical trials to assess its impact on clinical outcomes.
Daniel S Talmor; Henry E Fessler
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Respiratory care     Volume:  55     ISSN:  0020-1324     ISO Abbreviation:  Respir Care     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-01-28     Completed Date:  2010-05-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  162-72; discussion 172-4     Citation Subset:  IM    
Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston MA 02446, USA.
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MeSH Terms
Acute Lung Injury / therapy
Esophagus / physiology*
Manometry / methods*
Positive-Pressure Respiration / adverse effects*
Respiratory Distress Syndrome, Adult / therapy
Ventilator-Induced Lung Injury / prevention & control*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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