Current opinion in critical care · 2014
Monitoring of oesophageal pressure.
СтатьяОбзорНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Keller Steven P, Fessler Henry E
Аннотация
PURPOSE OF REVIEW: Studies in patients with acute respiratory distress syndrome (ARDS) have been unable to demonstrate a survival advantage with higher levels of positive end-expiratory pressure (PEEP) to open atelectatic lung regions or prevent their cyclic collapse. This review will discuss the challenges of accurately measuring pleural pressure with balloon-tipped catheters in the oesophagus, and the utility of such pressure monitoring to set PEEP and assess lung mechanics, focusing on patients with ARDS.
RECENT FINDINGS: Recent investigations have suggested that the monitoring of oesophageal pressure in ARDS patients may help individualize PEEP settings to optimize lung recruitment based on transpulmonary pressure.
SUMMARY: Changes in oesophageal pressure likely accurately reflect global changes in pleural pressure in supine patients with ARDS. However, absolute oesophageal pressure values in such patients may be subject to local artefacts and may substantially overestimate pleural pressure in other lung regions. Setting PEEP high enough to achieve a targeted end-expiratory transpulmonary pressure in the region of the oesophageal balloon catheter could overdistend other lung regions. Measurement of oesophageal pressure is feasible, but its clinical utility to titrate PEEP, compared with routine assessment, awaits experimental confirmation.
RECENT FINDINGS: Recent investigations have suggested that the monitoring of oesophageal pressure in ARDS patients may help individualize PEEP settings to optimize lung recruitment based on transpulmonary pressure.
SUMMARY: Changes in oesophageal pressure likely accurately reflect global changes in pleural pressure in supine patients with ARDS. However, absolute oesophageal pressure values in such patients may be subject to local artefacts and may substantially overestimate pleural pressure in other lung regions. Setting PEEP high enough to achieve a targeted end-expiratory transpulmonary pressure in the region of the oesophageal balloon catheter could overdistend other lung regions. Measurement of oesophageal pressure is feasible, but its clinical utility to titrate PEEP, compared with routine assessment, awaits experimental confirmation.