From the Department of Anesthesiology and Intensive Care, Maggiore della Carità University Hospital, Novara, Italy (G.C., I.S., R.P.) Department of Translational Medicine, Eastern Piedmont University, Novara, Italy (G.L., E.S., F.V., E.Boniolo, R.T., F.D.C., R.V.) Anesthesiology, Critical Care, and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy (E.Bignami) Anesthesia and Intensive Care, Policlinico S. Matteo IRCCS Foundation, Pavia, Italy (S.M., A.O., F.M.) Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of Anaesthesia and Intensive Care, University of Pavia, Pavia, Italy (E.A., F.M.).
Anesthesiology. 2020 Jul;133(1):145-153. doi: 10.1097/ALN.0000000000003327.
Esophageal balloon calibration was proposed in acute respiratory failure patients to improve esophageal pressure assessment. In a clinical setting characterized by a high variability of abdominal load and intrathoracic pressure (i.e., pelvic robotic surgery), the authors hypothesized that esophageal balloon calibration could improve esophageal pressure measurements. Accordingly, the authors assessed the impact of esophageal balloon calibration compared to conventional uncalibrated approach during pelvic robotic surgery.
In 30 adult patients, scheduled for elective pelvic robotic surgery, calibrated end-expiratory and end-inspiratory esophageal pressure, and the associated respiratory variations were obtained at baseline, after pneumoperitoneum-Trendelenburg application, and with positive end-expiratory pressure (PEEP) administration and compared to uncalibrated values measured at 4-ml filling volume, as per manufacturer recommendation. Data are expressed as median and [25th, 75th percentile].
Ninety calibrations were successfully performed. Chest wall elastance worsened with pneumoperitoneum-Trendelenburg and PEEP (19.0 [15.5, 24.6] and 16.7 [11.4, 21.7] cm H2O/l) compared to baseline (8.8 [6.3, 9.8] cm H2O/l; P < 0.0001 for both comparisons). End-expiratory and end-inspiratory calibrated esophageal pressure progressively increased from baseline (3.7 [2.2, 6.0] and 7.7 [5.9, 10.2] cm H2O) to pneumoperitoneum-Trendelenburg (6.2 [3.8, 10.2] and 16.1 [13.1, 20.6] cm H2O; P = 0.014 and P < 0.001) and PEEP (8.8 [7.7, 15.6] and 18.9 [16.3, 22.0] cm H2O; P < 0.0001 vs. baseline for both comparison; P < 0.001 and P = 0.002 vs. pneumoperitoneum-Trendelenburg) and, at each study step, they were persistently lower than uncalibrated esophageal pressure (P < 0.0001 for all comparisons). Overall, difference among uncalibrated and calibrated esophageal pressure was 5.1 [3.8, 8.4] cm H2O at end-expiration and 3.8 [3.0, 6.3] cm H2O at end-inspiration. Uncalibrated esophageal pressure swing was always lower than calibrated one (P < 0.0001 for all comparisons) with a difference of -1.0 [-1.8, -0.4] cm H2O.
In a clinical setting with variable chest wall mechanics, uncalibrated measurements substantially overestimated absolute values and underestimated respiratory variations of esophageal pressure. Calibration could substantially improve mechanical ventilation guided by esophageal pressure.
在急性呼吸衰竭患者中提出了食管球囊校准，以改善食管压力评估。在腹部负荷和胸腔内压力（即骨盆机器人手术）高度变化的临床环境中，作者假设食管球囊校准可以改善食管压力测量。因此，作者评估了在骨盆机器人手术期间与常规未校准方法相比食管球囊校准的影响。
在 30 名计划接受择期骨盆机器人手术的成年患者中，在基线时、在气腹-Trendelenburg 应用后、在呼气末正压（PEEP）给药时获得校准的呼气末和吸气末食管压力，以及相关的呼吸变化，并与制造商推荐的 4ml 充盈体积时测量的未校准值进行比较。数据表示为中位数和[25 分位，75 分位]。
成功完成了 90 次校准。与基线相比，气腹-Trendelenburg 和 PEEP 时胸壁弹性（19.0 [15.5, 24.6] 和 16.7 [11.4, 21.7] cm H2O/l）恶化（8.8 [6.3, 9.8] cm H2O/l；P < 0.0001 用于两种比较）。呼气末和吸气末校准后的食管压力从基线逐渐增加（3.7 [2.2, 6.0] 和 7.7 [5.9, 10.2] cm H2O）至气腹-Trendelenburg（6.2 [3.8, 10.2] 和 16.1 [13.1, 20.6] cm H2O；P = 0.014 和 P < 0.001）和 PEEP（8.8 [7.7, 15.6] 和 18.9 [16.3, 22.0] cm H2O；P < 0.0001 与基线相比，两种比较；P < 0.001 和 P = 0.002 与气腹-Trendelenburg 相比），并且在每个研究步骤中，它们都持续低于未校准的食管压力（所有比较的 P < 0.0001）。总体而言，呼气末时未校准和校准后的食管压力差值为 5.1 [3.8, 8.4] cm H2O，吸气末时为 3.8 [3.0, 6.3] cm H2O。未校准的食管压力波动始终低于校准后的食管压力（所有比较的 P < 0.0001），差值为-1.0 [-1.8, -0.4] cm H2O。
在胸壁力学变化的临床环境中，未校准的测量值大大高估了食管压力的绝对值，低估了呼吸变化。校准可以大大改善基于食管压力的机械通气。
