Esophageal Manometry and Regional Transpulmonary Pressure in Lung Injury

Imagem de Miniatura
Arquivos
art_YOSHIDA_Esophageal_Manometry_and_Regional_Transpulmonary_Pressure_in_Lung_2018.PDF (946.86 KB)
Citações na Scopus
154
Tipo de produção
article
Data de publicação
2018
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
AMER THORACIC SOC
Autores
YOSHIDA, Takeshi
GRIECO, Domenico Luca
CHEN, Lu
Citação
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, v.197, n.8, p.1018-1026, 2018
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
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.
Palavras-chave
esophageal manometry, transpulmonary pressure, acute respiratory distress syndrome
URI
https://observatorio.fm.usp.br/handle/OPI/26890
Referências
  1. AGOSTONI E, 1972, PHYSIOL REV, V52, P57
  2. Akoumianaki E, 2014, AM J RESP CRIT CARE, V189, P520, DOI 10.1164/rccm.201312-2193CI
  3. Amato MBP, 2015, NEW ENGL J MED, V372, P747, DOI 10.1056/NEJMsa1410639
  4. Amato MBP, 1998, NEW ENGL J MED, V338, P347, DOI 10.1056/NEJM199802053380602
  5. BAYDUR A, 1982, AM REV RESPIR DIS, V126, P788
  6. Bellani G, 2016, JAMA-J AM MED ASSOC, V315, P788, DOI 10.1001/jama.2016.0291
  7. Bellani G, 2011, AM J RESP CRIT CARE, V183, P1193, DOI 10.1164/rccm.201008-1318OC
  8. Borges JB, 2015, CRIT CARE MED, V43, pE123, DOI 10.1097/CCM.0000000000000926
  9. Brower RG, 2000, NEW ENGL J MED, V342, P1301
  10. Chiumello D, 2014, INTENS CARE MED, V40, P1670, DOI 10.1007/s00134-014-3415-4
  11. Costa ELV, 2009, INTENS CARE MED, V35, P1132, DOI 10.1007/s00134-009-1447-y
  12. Delisle S, 2016, AM J RESP CRIT CARE, V193
  13. Gattinoni L, 2004, CRIT CARE, V8, P350, DOI 10.1186/cc2854
  14. Gattinoni L, 2016, INTENS CARE MED, V42, P663, DOI 10.1007/s00134-015-4200-8
  15. Grasso S, 2012, INTENS CARE MED, V38, P395, DOI 10.1007/s00134-012-2490-7
  16. Gulati G, 2013, CRIT CARE MED, V41, P1951, DOI 10.1097/CCM.0b013e31828a3de5
  17. Hunter A, 2014, CLIN ANAT, V27, P853, DOI 10.1002/ca.22392
  18. KNOWLES JH, 1959, J APPL PHYSIOL, V14, P525
  19. LACHMANN B, 1980, ACTA ANAESTH SCAND, V24, P231, DOI 10.1111/j.1399-6576.1980.tb01541.x
  20. Loring SH, 2010, CRIT CARE MED, V38, P2358, DOI 10.1097/CCM.0b013e3181fa02b8
  21. Loring SH, 2010, J APPL PHYSIOL, V108, P515, DOI 10.1152/japplphysiol.00835.2009
  22. Mauri T, 2016, INTENS CARE MED, V42, P1360, DOI 10.1007/s00134-016-4400-x
  23. Mojoli F, 2016, CRIT CARE, V20, DOI 10.1186/s13054-016-1278-5
  24. Pelosi P, 2001, AM J RESP CRIT CARE, V164, P122, DOI 10.1164/ajrccm.164.1.2007010
  25. PELOSI P, 1994, AM J RESP CRIT CARE, V149, P8, DOI 10.1164/ajrccm.149.1.8111603
  26. Rodriguez ER, 2017, PROG CARDIOVASC DIS, V59, P327, DOI 10.1016/j.pcad.2016.12.010
  27. Staffieri F, 2012, CRIT CARE MED, V40, P2124, DOI 10.1097/CCM.0b013e31824e1b65
  28. Talmor D, 2008, NEW ENGL J MED, V359, P2095, DOI 10.1056/NEJMoa0708638
  29. Terragni PP, 2007, AM J RESP CRIT CARE, V175, P160, DOI 10.1164/rccm.200607-915OC
  30. Tsuchida S, 2006, AM J RESP CRIT CARE, V174, P279, DOI 10.1164/rccm.200506-1006OC
  31. Washko GR, 2006, J APPL PHYSIOL, V100, P753, DOI 10.1152/japplphysiol.00697.2005

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/09
Artigos e Materiais de Revistas Científicas - LIM/61