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Esophageal balloon calibration during Sigh: A physiologic, randomized, cross-over study
Gianmaria Cammarota1, Erminio Santangelo2, Gianluigi Lauro2
1Anesthesia and General Intensive Care, "Maggiore della Carità" University Hospital, Novara, Italy.
Journal of Critical Care
|November 6, 2020
Summary
Optimal esophageal balloon filling volume is higher during ventilator Sigh breaths compared to volume-controlled or pressure support breaths. This finding is crucial for accurate esophageal pressure measurements in critical care settings.
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- Accurate measurement of esophageal pressure (Pes) is vital for managing mechanically ventilated patients.
- Esophageal balloon filling volume (Vbest) influences Pes accuracy and is affected by intrathoracic pressure.
- Elevated intrathoracic pressure during ventilator Sigh breaths may necessitate adjustments in Vbest.
Purpose of the Study:
- To evaluate and compare the optimal esophageal balloon filling volume (Vbest) during different mechanical ventilation modes.
- Specifically, to compare Vbest during volume-controlled ventilation (VCV) and pressure support ventilation (PSV) versus PSV with Sigh breaths.
Main Methods:
- Twenty adult patients with hypoxemic acute respiratory failure requiring invasive mechanical ventilation were enrolled.
- An esophageal balloon catheter was used to measure Pes.
- Patients underwent trials of VCV, PSV, and PSV with Sigh breaths, with Vbest determined for each mode.
Main Results:
- Vbest was significantly higher during Sigh breaths (4.5 ml) compared to VCV (1.5 ml) and PSV tidal breaths (1.0 ml).
- Statistical analysis showed significant differences (P < 0.0001) between Sigh breaths and the other modes.
Conclusions:
- A higher optimal esophageal balloon filling volume is required during Sigh breaths for accurate Pes assessment.
- Ventilator mode, particularly the use of Sigh breaths, impacts the Vbest needed for reliable esophageal pressure monitoring.
