1
|
Jonkman AH, Telias I, Spinelli E, Akoumianaki E, Piquilloud L. The oesophageal balloon for respiratory monitoring in ventilated patients: updated clinical review and practical aspects. Eur Respir Rev 2023; 32:220186. [PMID: 37197768 PMCID: PMC10189643 DOI: 10.1183/16000617.0186-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/22/2023] [Indexed: 05/19/2023] Open
Abstract
There is a well-recognised importance for personalising mechanical ventilation settings to protect the lungs and the diaphragm for each individual patient. Measurement of oesophageal pressure (P oes) as an estimate of pleural pressure allows assessment of partitioned respiratory mechanics and quantification of lung stress, which helps our understanding of the patient's respiratory physiology and could guide individualisation of ventilator settings. Oesophageal manometry also allows breathing effort quantification, which could contribute to improving settings during assisted ventilation and mechanical ventilation weaning. In parallel with technological improvements, P oes monitoring is now available for daily clinical practice. This review provides a fundamental understanding of the relevant physiological concepts that can be assessed using P oes measurements, both during spontaneous breathing and mechanical ventilation. We also present a practical approach for implementing oesophageal manometry at the bedside. While more clinical data are awaited to confirm the benefits of P oes-guided mechanical ventilation and to determine optimal targets under different conditions, we discuss potential practical approaches, including positive end-expiratory pressure setting in controlled ventilation and assessment of inspiratory effort during assisted modes.
Collapse
Affiliation(s)
- Annemijn H Jonkman
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Irene Telias
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital-Unity Health Toronto, Toronto, ON, Canada
| | - Elena Spinelli
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Evangelia Akoumianaki
- Adult Intensive Care Unit, University Hospital of Heraklion, Heraklion, Greece
- Medical School, University of Crete, Heraklion, Greece
| | - Lise Piquilloud
- Adult Intensive Care Unit, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| |
Collapse
|
2
|
Gallardo A, Nuñez Silveira JM, Izza S, Ríos F. A "Novel" Asynchrony? Chest 2022; 162:e341-e342. [PMID: 36494139 DOI: 10.1016/j.chest.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Adrián Gallardo
- Servicio de Kinesiología, Clínica Modelo de Morón, Buenos Aires, Argentina.
| | - Juan M Nuñez Silveira
- Unidad de Terapia Intensiva, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago Izza
- Unidad de Terapia Intensiva, Hospital José María Cullen, Santa Fe, Argentina
| | - Fernando Ríos
- Unidad de Terapia Intensiva, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| |
Collapse
|
3
|
Ponomarev D, Brochard L, Goligher E. Expiratory Muscle Relaxation-Induced Ventilator Triggering: A New Dyssynchrony or an Established Physiological Phenomenon? Chest 2022; 162:e342-e343. [PMID: 36494140 DOI: 10.1016/j.chest.2022.08.2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Dmitry Ponomarev
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Ewan Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Heunks LMA, Roesthuis LH, Jonkman AH. Response. Chest 2022; 162:e343-e345. [PMID: 36494141 DOI: 10.1016/j.chest.2022.08.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Leo M A Heunks
- Department of Intensive Care Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Lisanne H Roesthuis
- Department of Intensive Care Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Annemijn H Jonkman
- Department of Intensive Care Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
5
|
Saavedra SN, Barisich PVS, Maldonado JBP, Lumini RB, Gómez-González A, Gallardo A. Asynchronies during invasive mechanical ventilation: narrative review and update. Acute Crit Care 2022; 37:491-501. [DOI: 10.4266/acc.2022.01158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/20/2022] [Indexed: 12/05/2022] Open
Abstract
Invasive mechanical ventilation is a frequent therapy in critically ill patients in critical care units. To achieve favorable outcomes, patient and ventilator interaction must be adequate. However, many clinical situations could attempt against this principle and generate a mismatch between these two actors. These asynchronies can lead the patient to worst outcomes; because of that is vital to recognize and treat these entities as soon as possible. Early detection and recognition of the different asynchronies could favor the reduction of the days of mechanical ventilation, the days of hospital stay, and in intensive care and improve clinical results.
Collapse
|
6
|
Pelosi P, Blanch L, Jabaudon M, Constantin JM. Automated systems to minimise asynchronies and personalise mechanical ventilation: A light at the end of the tunnel! Anaesth Crit Care Pain Med 2022; 41:101157. [PMID: 36108918 DOI: 10.1016/j.accpm.2022.101157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; Anaesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
| | - Lluis Blanch
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació I Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Sorbonne Université, GRC 29, Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier La Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013 Paris, France
| |
Collapse
|