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. 2021 Mar 8;7(1):00646-2020.
doi: 10.1183/23120541.00646-2020. eCollection 2021 Jan.

Oesophageal pressure as a surrogate of pleural pressure in mechanically ventilated patients

Antoine Tilmont  1   2 , Benjamin Coiffard  1   2 , Takeshi Yoshida  3   4 , Florence Daviet  1   2 , Karine Baumstarck  2 , Geoffrey Brioude  5 , Sami Hraiech  1   2 , Jean-Marie Forel  1   2 , Antoine Roch  1   6 , Laurent Brochard  4   7 , Laurent Papazian  1   4 , Christophe Guervilly  1   4
Affiliations

Oesophageal pressure as a surrogate of pleural pressure in mechanically ventilated patients

Antoine Tilmont et al. ERJ Open Res. .

Abstract

Background: Oesophageal pressure (P oes) is used to approximate pleural pressure (P pl) and therefore to estimate transpulmonary pressure (P L). We aimed to compare oesophageal and regional pleural pressures and to calculate transpulmonary pressures in a prospective physiological study on lung transplant recipients during their stay in the intensive care unit of a tertiary university hospital.

Methods: Lung transplant recipients receiving invasive mechanical ventilation and monitored by oesophageal manometry and dependent and nondependent pleural catheters were investigated during the post-operative period. We performed simultaneous short-time measurements and recordings of oesophageal manometry and pleural pressures. Expiratory and inspiratory P L were computed by subtracting regional P pl or P oes from airway pressure; inspiratory P L was also calculated with the elastance ratio method.

Results: 16 patients were included. Among them, 14 were analysed. Oesophageal pressures correlated with dependent and nondependent pleural pressures during expiration (R2=0.71, p=0.005 and R2=0.77, p=0.001, respectively) and during inspiration (R2=0.66 for both, p=0.01 and p=0.014, respectively). P L values calculated using P oes were close to those obtained from the dependent pleural catheter but higher than those obtained from the nondependent pleural catheter both during expiration and inspiration.

Conclusions: In ventilated lung transplant recipients, oesophageal manometry is well correlated with pleural pressure. The absolute value of P oes is higher than P pl of nondependent lung regions and could therefore underestimate the highest level of lung stress in those at high risk of overinflation.

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Conflict of interest statement

Conflict of interest: A. Tilmont has nothing to disclose. Conflict of interest: B. Coiffard has nothing to disclose. Conflict of interest: T. Yoshida has nothing to disclose. Conflict of interest: F. Daviet has nothing to disclose. Conflict of interest: K. Baumstarck has nothing to disclose. Conflict of interest: G. Brioude has nothing to disclose. Conflict of interest: S. Hraiech has nothing to disclose. Conflict of interest: J-M. Forel has nothing to disclose. Conflict of interest: A. Roch has nothing to disclose. Conflict of interest: L. Brochard reports grants from Medtronic Covidien, grants and nonfinancial support from Fisher Paykel, nonfinancial support from Sentec, Philips and Air Liquide, and other support from General Electric, outside the submitted work. Conflict of interest: L. Papazian reports grants and personal fees from Air Liquid, personal fees from Faron, grants from SEDANA and personal fees from MSD, outside the submitted work. Conflict of interest: C. Guervilly reports personal fees from Xenios Fresenus Medical Care and MSD outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Flow diagram of the included patients. ICU: intensive care unit.
FIGURE 2
FIGURE 2
Representative tracings of volume, flow, and airway, oesophageal and nondependent pleural pressures during an occlusion test. The increase of airway, oesophageal and nondependent pleural pressures of the same magnitude during gentle thoracic compression (white arrows) ensures the correct placement of the pleural catheter and oesophageal balloon.
FIGURE 3
FIGURE 3
a, c) Correlations and b, d) Bland–Altman analysis between a, b) dependent and c, d) nondependent pleural pressures and oesophageal pressure at end-expiration. a, c) Dashed line represents the identity line. b, d) Solid and dashed lines represent mean±1.96 sd of the differences. Each circle represents a different patient.
FIGURE 4
FIGURE 4
a, c) Correlations and b, d) Bland–Altman analysis between a, b) dependent and c, d) nondependent pleural pressures and oesophageal pressure at end-inspiration. a, c) Dashed line represents the identity line. b, d) Solid and dashed lines represent mean±1.96 sd of the differences. Each circle represents a different patient.
FIGURE 5
FIGURE 5
a, c, e) Correlations and b, d, f) Bland–Altman analysis between transpulmonary pressures calculated using a, b) elastance ratio, c, d) dependent pleural pressure and e, f) nondependent pleural pressure during end-inspiration. a, c, e) Dashed line represents the identity line. b, d, f) Solid and dashed lines represent mean±1.96 sd of the differences. Each circle represents a different patient.
FIGURE 6
FIGURE 6
a, c) Correlations and b, d) Bland–Altman analysis between transpulmonary pressures calculated using a, b) dependent and c, d) nondependent pleural pressure during end-expiration. a, c, e) Dashed line represents the identity line. b, d, f) Solid and dashed lines represent mean±1.96 sd of the differences. Each circle represents a different patient.
FIGURE 7
FIGURE 7
Relationship of transpulmonary pressures calculated from oesophageal pressure and pleural pressures in mechanically ventilated human lung transplant recipients during a) expiratory time and b) inspiratory time at different positive end-expiratory pressure (PEEP) levels. *: p<0.05 compared with Poes and the dependent catheter by the post hoc Bonferroni test. Boxes represent median and interquartile range; whiskers represent minimum–maximum range. Outliers are represented by circles. See Methods for definitions and calculations.
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