Tilmont Antoine, Coiffard Benjamin, Yoshida Takeshi, Daviet Florence, Baumstarck Karine, Brioude Geoffrey, Hraiech Sami, Forel Jean-Marie, Roch Antoine, Brochard Laurent, Papazian Laurent, Guervilly Christophe
Médecine Intensive Réanimation, Hôpital Nord, AP-HM, Marseille, France.
Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et Qualité de Vie EA 3279, Aix-Marseille Université, Marseille, France.
ERJ Open Res. 2021 Mar 8;7(1). doi: 10.1183/23120541.00646-2020. eCollection 2021 Jan.
Oesophageal pressure ( ) is used to approximate pleural pressure ( ) and therefore to estimate transpulmonary pressure ( ). We aimed to compare oesophageal and regional pleural pressures and to calculate transpulmonary pressures in a prospective physiological study on lung transplant recipients during their stay in the intensive care unit of a tertiary university hospital.
Lung transplant recipients receiving invasive mechanical ventilation and monitored by oesophageal manometry and dependent and nondependent pleural catheters were investigated during the post-operative period. We performed simultaneous short-time measurements and recordings of oesophageal manometry and pleural pressures. Expiratory and inspiratory were computed by subtracting regional or from airway pressure; inspiratory was also calculated with the elastance ratio method.
16 patients were included. Among them, 14 were analysed. Oesophageal pressures correlated with dependent and nondependent pleural pressures during expiration (R=0.71, p=0.005 and R=0.77, p=0.001, respectively) and during inspiration (R=0.66 for both, p=0.01 and p=0.014, respectively). values calculated using were close to those obtained from the dependent pleural catheter but higher than those obtained from the nondependent pleural catheter both during expiration and inspiration.
In ventilated lung transplant recipients, oesophageal manometry is well correlated with pleural pressure. The absolute value of is higher than of nondependent lung regions and could therefore underestimate the highest level of lung stress in those at high risk of overinflation.
食管压力（ ）用于近似胸膜压力（ ），从而估计跨肺压（ ）。在一项针对三级大学医院重症监护病房中肺移植受者的前瞻性生理学研究中，我们旨在比较食管压力和局部胸膜压力，并计算跨肺压。
在术后期间，对接受有创机械通气并通过食管测压法以及依赖和非依赖胸膜导管进行监测的肺移植受者进行了研究。我们同时进行了食管测压法和胸膜压力的短期测量与记录。呼气末和吸气末 通过从气道压力中减去局部 或 来计算；吸气末 也采用弹性比法进行计算。
纳入了16例患者。其中，14例进行了分析。呼气期间（分别为R = 0.71，p = 0.005和R = 0.77，p = 0.001）和吸气期间（两者均为R = 0.66，p = 0.01和p = 0.014），食管压力与依赖和非依赖胸膜压力相关。使用 计算的 值在呼气和吸气期间均接近从依赖胸膜导管获得的值，但高于从非依赖胸膜导管获得的值。
在接受机械通气的肺移植受者中，食管测压法与胸膜压力具有良好的相关性。 的绝对值高于非依赖肺区域的 ，因此可能会低估那些有过度充气高风险患者的最高肺应力水平。
