1
|
Sun XM, Chen GQ, Huang HW, He X, Yang YL, Shi ZH, Xu M, Zhou JX. Use of esophageal balloon pressure-volume curve analysis to determine esophageal wall elastance and calibrate raw esophageal pressure: a bench experiment and clinical study. BMC Anesthesiol 2018; 18:21. [PMID: 29444644 PMCID: PMC5813414 DOI: 10.1186/s12871-018-0488-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 02/08/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Accurate measurement of esophageal pressure (Pes) depends on proper filling of the balloon. Esophageal wall elastance (Ees) may also influence the measurement. We examined the estimation of balloon-surrounding elastance in a bench model and investigated a simplified calibrating procedure of Pes in a balloon with relatively small volume. METHODS The Cooper balloon catheter (geometric volume of 2.8 ml) was used in the present study. The balloon was progressively inflated in different gas-tight glass chambers with different inner volumes. Chamber elastance was measured by the fitting of chamber pressure and balloon volume. Balloon pressure-volume (P-V) curves were obtained, and the slope of the intermediate linear section was defined as the estimated chamber elastance. Balloon volume tests were also performed in 40 patients under controlled ventilation. The slope of the intermediate linear section on the end-expiratory esophageal P-V curve was calculated as the Ees. The balloon volume with the largest Pes tidal swing was defined as the best volume. Pressure generated by the esophageal wall during balloon inflation (Pew) was estimated as the product of Ees and best volume. Because the clinical intermediate linear section enclosed filling volume of 0.6 to 1.4 ml in each of the patient, we simplified the estimation of Ees by only using parameters at these two filling volumes. RESULTS In the bench experiment, bias (lower and upper limits of agreement) was 0.5 (0.2 to 0.8) cmH2O/ml between the estimated and measured chamber elastance. The intermediate linear section on the clinical and bench P-V curves resembled each other. Median (interquartile range) Ees was 3.3 (2.5-4.1) cmH2O/ml. Clinical best volume was 1.0 (0.8-1.2) ml and ranged from 0.6 to 1.4 ml. Estimated Pew at the best volume was 2.8 (2.5-3.5) cmH2O with a maximum value of 5.2 cmH2O. Compared with the conventional method, bias (lower and upper limits of agreement) of Ees estimated by the simple method was - 0.1 (- 0.7 to 0.6) cmH2O/ml. CONCLUSIONS The slope of the intermediate linear section on the balloon P-V curve correlated with the balloon-surrounding elastance. The estimation of Ees and calibration of Pes were feasible for a small-volume-balloon. TRIAL REGISTRATION Identifier NCT02976844 . Retrospectively registered on 29 November 2016.
Collapse
Affiliation(s)
- Xiu-Mei Sun
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Address: No 6, Tiantan Xili, Dongcheng district, Beijing, 100050, China
| | - Guang-Qiang Chen
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Address: No 6, Tiantan Xili, Dongcheng district, Beijing, 100050, China
| | - Hua-Wei Huang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Address: No 6, Tiantan Xili, Dongcheng district, Beijing, 100050, China
| | - Xuan He
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Address: No 6, Tiantan Xili, Dongcheng district, Beijing, 100050, China
| | - Yan-Lin Yang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Address: No 6, Tiantan Xili, Dongcheng district, Beijing, 100050, China
| | - Zhong-Hua Shi
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Address: No 6, Tiantan Xili, Dongcheng district, Beijing, 100050, China
| | - Ming Xu
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Address: No 6, Tiantan Xili, Dongcheng district, Beijing, 100050, China
| | - Jian-Xin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Address: No 6, Tiantan Xili, Dongcheng district, Beijing, 100050, China.
| |
Collapse
|
2
|
Yang YL, He X, Sun XM, Chen H, Shi ZH, Xu M, Chen GQ, Zhou JX. Optimal esophageal balloon volume for accurate estimation of pleural pressure at end-expiration and end-inspiration: an in vitro bench experiment. Intensive Care Med Exp 2017; 5:35. [PMID: 28770541 PMCID: PMC5540740 DOI: 10.1186/s40635-017-0148-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Esophageal pressure, used as a surrogate for pleural pressure, is commonly measured by air-filled balloon, and the accuracy of measurement depends on the proper balloon volume. It has been found that larger filling volume is required at higher surrounding pressure. In the present study, we determined the balloon pressure-volume relationship in a bench model simulating the pleural cavity during controlled ventilation. The aim was to confirm whether an optimal balloon volume range existed that could provide accurate measurement at both end-expiration and end-inspiration. METHODS We investigated three esophageal balloons with different dimensions and materials: Cooper, SmartCath-G, and Microtek catheters. The balloon was introduced into a glass chamber simulating the pleural cavity and volume-controlled ventilation was initiated. The ventilator was set to obtain respective chamber pressures of 5 and 20 cmH2O during end-expiratory and end-inspiratory occlusion. Balloon was progressively inflated, and balloon pressure and chamber pressure were measured. Balloon transmural pressure was defined as the difference between balloon and chamber pressure. The balloon pressure-volume curve was fitted by sigmoid regression, and the minimal and maximal balloon volume accurately reflecting the surrounding pressure was estimated using the lower and upper inflection point of the fitted sigmoid curve. Balloon volumes at end-expiratory and end-inspiratory occlusion were explored, and the balloon volume range that provided accurate measurement at both phases was defined as the optimal filling volume. RESULTS Sigmoid regression of the balloon pressure-volume curve was justified by the dimensionless variable fitting and residual distribution analysis. All balloon transmural pressures were within ±1.0 cmH2O at the minimal and maximal balloon volumes. The minimal and maximal balloon volumes during end-inspiratory occlusion were significantly larger than those during end-expiratory occlusion, except for the minimal volume in Cooper catheter. Mean (±standard deviation) of optimal filling volume both suitable for end-expiratory and end-inspiratory measurement ranged 0.7 ± 0.0 to 1.7 ± 0.2 ml in Cooper, 1.9 ± 0.2 to 3.6 ± 0.3 ml in SmartCath-G, and 2.2 ± 0.2 to 4.6 ± 0.1 ml in Microtek catheter. CONCLUSIONS In each of the tested balloon, an optimal filling volume range was found that provided accurate measurement during both end-expiratory and end-inspiratory occlusion.
Collapse
Affiliation(s)
- Yan-Lin Yang
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, No 6, Tiantan Xili, Dongcheng District, Beijing, 100050, China.,Intensive Care Unit, Beijing Electric Power Hospital, Capital Medical University, Beijing, 100073, China
| | - Xuan He
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, No 6, Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Xiu-Mei Sun
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, No 6, Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Han Chen
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, No 6, Tiantan Xili, Dongcheng District, Beijing, 100050, China.,Surgical Intensive Care Unit, Fujian Provincial Clinical College Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Zhong-Hua Shi
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, No 6, Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Ming Xu
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, No 6, Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Guang-Qiang Chen
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, No 6, Tiantan Xili, Dongcheng District, Beijing, 100050, China
| | - Jian-Xin Zhou
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, No 6, Tiantan Xili, Dongcheng District, Beijing, 100050, China.
| |
Collapse
|
3
|
Cross TJ, Beck KC, Johnson BD. Correcting the dynamic response of a commercial esophageal balloon-catheter. J Appl Physiol (1985) 2016; 121:503-11. [PMID: 27402558 DOI: 10.1152/japplphysiol.00155.2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/03/2016] [Indexed: 11/22/2022] Open
Abstract
It is generally recommended that an esophageal balloon-catheter possess an adequate frequency response up to 15 Hz, such that parameters of respiratory mechanics may be quantified with precision. In our experience, however, we have observed that some commercially available systems do not display an ideal frequency response (<8-10 Hz). We therefore investigated whether the poor frequency response of a commercially available esophageal catheter may be adequately compensated using two numerical techniques: 1) an exponential model correction, and 2) Wiener deconvolution. These two numerical techniques were performed on a commercial balloon-catheter interfaced with 0, 1, and 2 lengths of extension tubing (90 cm each), referred to as configurations L0, L90, and L180, respectively. The frequency response of the balloon-catheter in these configurations was assessed by empirical transfer function analysis, and its "working" range was defined as the frequency beyond which more than 5% amplitude and/or phase distortion was observed. The working frequency range of the uncorrected balloon-catheter extended up to only 10 Hz for L0, and progressively worsened with additional tubing length (L90 = 3 Hz, L180 = 2 Hz). Although both numerical methods of correction adequately enhanced the working frequency range of the balloon-catheter to beyond 25 Hz for all length configurations (L0, L90, and L180), Wiener deconvolution consistently provided more accurate corrections. Our data indicate that Wiener deconvolution provides a superior correction of the balloon-catheter's dynamic response, and is relatively more robust to extensions in catheter tube length compared with the exponential correction method.
Collapse
Affiliation(s)
- Troy J Cross
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; and Menzie Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Kenneth C Beck
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; and
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; and
| |
Collapse
|