Measurement of pleural pressure with esophageal balloon in anesthetized humans

Simultaneous measurement of tracheal and esophageal pressures during occluded inspiratory efforts (occlusion test) was used to assess the validity of the esophageal balloon technique in anesthetized supine subjects. Ten ASA 1 patients undergoing general anesthesia (halothane 1 MAC, nitrous oxide 70%, and oxygen) for minor surgery were studied. Esophageal pressure (Pes) was measured using a 5-cm-long balloon and was plotted against tracheal pressure (Pt). Occlusion tests were performed at end expiration with the balloon top positioned 5, 10, 15, and 20 cm above the cardia. The results show that with the balloon positioned at the classical level of 10 cm above the cardia, the difference between delta Pes and delta Pt did not exceed 8% in seven of 10 subjects. In the remaining three, however, the difference between delta Pes and delta Pt ranged between +20% and -40%. By repositioning the balloon to 5 or 15 cm above the cardia, a locus was found in all subjects where the difference is less than 10%. We conclude that the esophageal balloon technique can be used in anesthetized supine subjects to give reliable measurements of changes in pleural pressure, provided that it is validated with the occlusion test.