open access

Vol 47 (2015): Special issue
Review articles
Published online: 2015-11-17
Submitted: 2015-09-21
Accepted: 2015-10-12
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Transpulmonary pressure monitoring during mechanical ventilation: a bench-to-bedside review

Cristina Mietto, Manu L.N.G. Malbrain, Davide Chiumello
DOI: 10.5603/AIT.a2015.0065

open access

Vol 47 (2015): Special issue
Review articles
Published online: 2015-11-17
Submitted: 2015-09-21
Accepted: 2015-10-12

Abstract

Different ventilation strategies have been suggested in the past in patients with acute respiratory distress syndrome
(ARDS). Airway pressure monitoring alone is inadequate to assure optimal ventilatory support in ARDS patients. The
assessment of transpulmonary pressure (PTP) can help clinicians to tailor mechanical ventilation to the individual
patient needs. Transpulmonary pressure monitoring, defined as airway pressure (Paw) minus intrathoracic pressure
(ITP), provides essential information about chest wall mechanics and its effects on the respiratory system and lung
mechanics. The positioning of an esophageal catheter is required to measure the esophageal pressure (Peso), which is
clinically used as a surrogate for ITP or pleural pressure (Ppl), and calculates the transpulmonary pressure. The benefits
of such a ventilation approach are avoiding excessive lung stress and individualizing the positive end-expiratory pressure (PEEP) setting. The aim is to prevent over-distention of alveoli and the cyclic recruitment/derecruitment or shear stress of lung parenchyma, mechanisms associated with ventilator-induced lung injury (VILI). Knowledge of the real lung distending pressure, i.e. the transpulmonary pressure, has shown to be useful in both controlled and assisted
mechanical ventilation. In the latter ventilator modes, Peso measurement allows one to assess a patient’s respiratory
effort, patient-ventilator asynchrony, intrinsic PEEP and the calculation of work of breathing. Conditions that have
an impact on Peso, such as abdominal hypertension, will also be discussed briefly.

Abstract

Different ventilation strategies have been suggested in the past in patients with acute respiratory distress syndrome
(ARDS). Airway pressure monitoring alone is inadequate to assure optimal ventilatory support in ARDS patients. The
assessment of transpulmonary pressure (PTP) can help clinicians to tailor mechanical ventilation to the individual
patient needs. Transpulmonary pressure monitoring, defined as airway pressure (Paw) minus intrathoracic pressure
(ITP), provides essential information about chest wall mechanics and its effects on the respiratory system and lung
mechanics. The positioning of an esophageal catheter is required to measure the esophageal pressure (Peso), which is
clinically used as a surrogate for ITP or pleural pressure (Ppl), and calculates the transpulmonary pressure. The benefits
of such a ventilation approach are avoiding excessive lung stress and individualizing the positive end-expiratory pressure (PEEP) setting. The aim is to prevent over-distention of alveoli and the cyclic recruitment/derecruitment or shear stress of lung parenchyma, mechanisms associated with ventilator-induced lung injury (VILI). Knowledge of the real lung distending pressure, i.e. the transpulmonary pressure, has shown to be useful in both controlled and assisted
mechanical ventilation. In the latter ventilator modes, Peso measurement allows one to assess a patient’s respiratory
effort, patient-ventilator asynchrony, intrinsic PEEP and the calculation of work of breathing. Conditions that have
an impact on Peso, such as abdominal hypertension, will also be discussed briefly.

Get Citation

Keywords

abdominal pressure, esophageal pressure, transpulmonary pressure, work of breathing, mechanical ventilation

About this article
Title

Transpulmonary pressure monitoring during mechanical ventilation: a bench-to-bedside review

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 47 (2015): Special issue

Pages

27-37

Published online

2015-11-17

DOI

10.5603/AIT.a2015.0065

Keywords

abdominal pressure
esophageal pressure
transpulmonary pressure
work of breathing
mechanical ventilation

Authors

Cristina Mietto
Manu L.N.G. Malbrain
Davide Chiumello

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