The assessment of esophageal pressure using different devices: a validation study

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Medical Device Technology

Background:

• Esophageal pressure measurement aids in ventilatory management for acute respiratory distress syndrome (ARDS) but is primarily used in research.
• Accurate esophageal pressure monitoring is crucial for optimizing mechanical ventilation strategies.

Purpose of the Study:

• To compare measurements of end-expiratory esophageal pressure, transpulmonary pressure, and lung stress using a manual gold standard device, a new automatic system (Optivent), and a bedside system.
• To assess the clinical acceptability and potential for wider application of non-research-grade esophageal pressure measurement tools.

Main Methods:

• Esophageal pressure was measured in 40 sedated, paralyzed, mechanically ventilated ARDS patients at three positive end-expiratory pressure (PEEP) levels.
• Measurements were compared between a dedicated manual device (gold standard), the Optivent system, and a bedside system (ventilator + hemodynamic monitor).

Main Results:

• Mean esophageal pressures measured by the dedicated, bedside, and Optivent systems were 10.0±4.2, 10±4, and 9.9±4.0 cmH2O, respectively.
• Bias and limits of agreement indicated clinical acceptability for both Optivent and the bedside system compared to the gold standard for esophageal pressure, transpulmonary pressure, and lung stress.
• Specific bias values for esophageal pressure were 0.2 cmH2O (Optivent) and -0.1 cmH2O (bedside).

Conclusions:

• Both the Optivent system and the bedside equipment demonstrated clinical acceptability when compared to a gold standard device.
• The availability and validation of these systems may facilitate broader clinical adoption of esophageal pressure monitoring in ARDS management.
• Wider use of esophageal pressure measurement can potentially improve ventilatory strategies and patient outcomes in ARDS.