A simple method for assessing the validity of the esophageal balloon technique

The validity of the conventional esophageal balloon technique as a measure of pleural pressure was tested in 10 subjects in sitting, supine, and lateral positions by occluding the airways at end-expiration and measuring the ratio of changes in esophageal (delta Pes) and mouth pressure (delta Pm) during the ensuing spontaneous occluded inspiratory efforts. Similar measurements were also made during static Mueller maneuvers. In both tests, delta Pes/delta Pm values were close to unity in sitting and lateral positions, whereas in the supine position, substantial deviations from unity were found in some instances. However, by repositioning the balloon to different levels in the esophagus, even in these instances a locus could be found where the delta Pes/delta Pm ratio was close to unity. No appreciable phase difference between delta Pes and delta Pm was found. We conclude that by positioning the balloon according to the "occlusion test" procedure, valid measurements of pleural pressure can be obtained in all the tested body positions.