Esophageal Manometry and Regional Transpulmonary Pressure in Lung Injury

Autor(es):Mostrar menos -

Yoshida, Takeshi ^{[1, 2, 3, 4]} ; Amato, Marcelo B. P. ^[5] ; Grieco, Domenico Luca ^{[2, 3, 6, 7, 4, 8]} ; Chen, Lu ^{[2, 3, 4]} ; Lima, Cristhiano A. S. ^[5] ; Roldan, Rollin ^{[5, 9]} ; Morais, Caio C. A. ^[5] ; Gomes, Susimeire ^[5] ; Costa, Eduardo L. V. ^[5] ; Cardoso, Paulo F. G. ^[10] ; Charbonney, Emmanuel ^{[6, 7, 11]} ; Richard, Jean-Christophe M. ^{[6, 7, 12]} ; Brochard, Laurent ^{[1, 6, 7, 4]} ; Kavanagh, Brian P. ^{[1, 2, 3]}

Afiliação do(s) autor(es):Mostrar menos -

^[1] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON - Canada

^[2] Univ Toronto, Hosp Sick Children, Dept Crit Care Med, Translat Med, Toronto, ON - Canada

^[3] Univ Toronto, Hosp Sick Children, Dept Anesthesia, Translat Med, Toronto, ON - Canada

^[4] St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, 30 Bond St, Toronto, ON M5B 1W8 - Canada

^[5] Univ Sao Paulo, Fac Med, Hosp Clin, Inst Coracao, Div Pneumol, Sao Paulo - Brazil

^[6] Univ Quebec Trois Rivieres, Cardiac Arrest & Ventilat Int Assoc Res, Lab Anat, Trois Rivieres, PQ - Canada

^[7] Ctr Integre Univ Sante & Serv Sociaux Mauricie &, Trois Rivieres, PQ - Canada

^[8] Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli, Dept Anesthesiol & Intens Care Med, Rome - Italy

^[9] Hosp Rebagliati, Unidad Cuidados Intensivos, Lima - Peru

^[10] Univ Sao Paulo, Fac Med, Hosp Clin, Inst Coracao, Disciplina Cirurgia Toracia, Sao Paulo - Brazil

^[11] Hop Sacre Coeur, Ctr Rech, Montreal, PQ - Canada

^[12] Gen Hosp Annecy, Dept Prehosp & Emergency Med, Annecy - France

• Tipo de documento: Artigo Científico
• Fonte: American Journal of Respiratory and Critical Care Medicine; v. 197, n. 8, p. 1018-1026, APR 15 2018.
• Citações Web of Science: 44

Resumo

Rationale: Esophageal manometry is the clinically available method to estimate pleural pressure, thus enabling calculation of transpulmonary pressure (PL). However, many concerns make it uncertaininwhich lung region esophagealmanometry reflects local PL. Objectives: To determine the accuracy of esophageal pressure (Pes) and in which regions esophageal manometry reflects pleural pressure (Ppl) and PL; to assess whether lung stress in nondependent regions can be estimated at end-inspiration from PL. Methods: In lung-injured pigs (n = 6) and human cadavers (n = 3), Pes was measured across a range of positive end-expiratory pressure, together with directly measured Ppl in nondependent and dependent pleural regions. All measurements were obtained with minimal nonstressed volumes in the pleural sensors and esophageal balloons. Expiratory and inspiratory PL was calculated by subtracting local Ppl or Pes from airway pressure; inspiratory PL was also estimated by subtracting Ppl (calculated from chest wall and respiratory system elastance) from the airway plateau pressure. Measurements and Main Results: In pigs and human cadavers, expiratory and inspiratory PL using Pes closely reflected values in dependent to middle lung (adjacent to the esophagus). Inspiratory PL estimated from elastance ratio reflected the directly measured nondependent values. Conclusions: These data support the use of esophageal manometry in acute respiratory distress syndrome. Assuming correct calibration, expiratory PL derived from Pes reflects PL in dependent to middle lung, where atelectasis usually predominates; inspiratory PL estimated from elastance ratio may indicate the highest level of lung stress in nondependent ``baby{''} lung, where it is vulnerable to ventilator-induced lung injury. (AU)

• Processo FAPESP: 14/02030-7 - Respiração espontânea durante ventilação mecânica em modelo experimental de lesão pulmonar aguda: avaliação da inflamação pulmonar por PET-CT usando dois valores de pressão positiva ao final da expiração (PEEP)
• Beneficiário: Eduardo Leite Vieira Costa
• Modalidade de apoio: Auxílio à Pesquisa - Regular