Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives
Por:
Mauri, T, Yoshida, T, Bellani, G, Goligher, E, Carteaux, G, Rittayamai, N, Mojoli, F, Chiumello, D, Piquilloud, L, Grasso, S, Jubran, A, Laghi, F, Magder, S, Pesenti, A, Loring, S, Gattinoni, L, Talmor, D, Blanch, L, Amato, M, Chen, L, Brochard, L, Mancebo, J
Publicada:
1 sep 2016
Resumen:
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.
This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes.
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.
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.
Filiaciones:
Mauri, T:
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Anesthesia Crit Care & Emergency, Milan, Italy
Yoshida, T:
Univ Toronto, Hosp Sick Children, Dept Crit Care Med, Toronto, ON, Canada
Osaka Univ Hosp, Intens Care Unit, Suita, Osaka, Japan
Univ Toronto, Hosp Sick Children, Dept Anesthesia, Toronto, ON, Canada
Bellani, G:
Univ Milano Bicocca, Dept Hlth Sci, Monza, MB, Italy
Goligher, E:
Univ Toronto, Dept Physiol, Toronto, ON, Canada
Mt Sinai Hosp, Toronto, ON, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Carteaux, G:
CHU Henri Mondor, AP HP, DHU A TVB, Serv Reanimat Med, Creteil, France
Univ Paris Est Creteil, Grp Rech Clin CARMAS, Fac Med Creteil, Creteil, France
Rittayamai, N:
Siriraj Hosp, Div Resp Dis & TB, Dept Med, Fac Med, Bangkok, Thailand
St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Mojoli, F:
Univ Pavia, Fdn IRCCS Policlin San Matteo, Anesthesia & Intens Care, Pavia, Italy
Chiumello, D:
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Anesthesia Crit Care & Emergency, Milan, Italy
Univ Milan, Dipartimento Fisiopatol Med Chirurg & Trapianti, Milan, Italy
Piquilloud, L:
Univ Hosp Lausanne, Adult Intens Care & Burn Unit, Lausanne, Switzerland
Univ Hosp Angers, Dept Med Intens Care, Angers, France
Grasso, S:
Univ Bari Aldo Moro, DETO, Sez Anestesiol & Rianimaz, Bari, Italy
Jubran, A:
Edward Hines Jr Vet Affairs Hosp, Div Pulm & Crit Care Med, Hines, IL USA
Loyola Univ, Chicago Stritch Sch Med, Hines, IL USA
Laghi, F:
Edward Hines Jr Vet Affairs Hosp, Div Pulm & Crit Care Med, Hines, IL USA
Loyola Univ, Chicago Stritch Sch Med, Hines, IL USA
Magder, S:
McGill Univ, Heath Ctr, Dept Crit Care, Glen Site Campus, Montreal, PQ, Canada
Pesenti, A:
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Anesthesia Crit Care & Emergency, Milan, Italy
Univ Milan, Dipartimento Fisiopatol Med Chirurg & Trapianti, Milan, Italy
Loring, S:
Beth Israel Deaconess Med Ctr, Dept Anesthesia Crit Care & Pain Med, Boston, MA 02215 USA
Harvard Med Sch, Boston, MA USA
Gattinoni, L:
Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Anesthesia Crit Care & Emergency, Milan, Italy
Univ Milan, Dipartimento Fisiopatol Med Chirurg & Trapianti, Milan, Italy
Talmor, D:
Beth Israel Deaconess Med Ctr, Dept Anesthesia Crit Care & Pain Med, Boston, MA 02215 USA
Harvard Med Sch, Boston, MA USA
Blanch, L:
Univ Autonoma Barcelona, Inst Invest & Innovacio Parc Tauli, CIBER Enfermedades Resp, Crit Care Ctr,Parc Tauli Hosp Univ, Sabadell, Spain
Amato, M:
Univ Sao Paulo, Div Pulm, Heart Inst InCor, Hosp Clin, Sao Paulo, Brazil
Chen, L:
St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Brochard, L:
St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, Toronto, ON, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Mancebo, J:
Hosp Santa Creu & Sant Pau, Serv Med Intens, Barcelona, Spain
Green Published
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