A novel method for transpulmonary pressure estimation using fluctuation of central venous pressure.

The objective of the study is to develop a correction method for estimating the change in pleural pressure (ΔPpl) and plateau transpulmonary pressure (P) by using the change in central venous pressure (ΔCVP). Seven children (aged < 15 years) with acute respiratory failure (PaO/FO < 300 mmHg), who were paralyzed and mechanically ventilated with a PEEP of < 10 cmHO and had central venous catheters and esophageal balloon catheters placed for clinical purposes, were enrolled prospectively. We compared change in esophageal pressure (ΔPes), ΔCVP, and ΔPpl calculated using a corrected ΔCVP (cΔCVP-derived ΔPpl). cΔCVP-derived ΔPpl was calculated as κ × ΔCVP, where κ was the ratio of the change in airway pressure (ΔPaw) to ΔCVP during the occlusion test. cΔCVP-derived ΔPpl correlated better than ΔCVP with ΔPes (R = 0.48, p = 0.08 vs. R = 0.14, p = 0.4) with lesser bias and precision in Bland-Altman analysis. The plateau P calculated using the cΔCVP-derived ΔPpl (17.6 ± 2.6 cmHO) correlated well with the ΔPes-derived plateau P (18.1 ± 2.3 cmHO) (R = 0.90, p = 0.001). Our correction method can estimate ΔPpl and plateau P from ΔCVP with a reasonable accuracy in paralyzed and mechanically ventilated pediatric patients with respiratory failure.