Segura LV, González MKI, Morales RJD, Velázquez CA

Language: Spanish
References: 21
Page: 198-202
PDF size: 299.69 Kb.

ABSTRACT

The monitoring of obese patients represents great challenges for the intensive care physician, due to the physiological alterations presented by these patients and the marked increase in the population of patients with obesity in critical care units, secondary to the barriers imposed by the physiology of obese patients, the measurement of pleural pressure, which is a fundamental physiological measurement in each breath, would be ideal in this type of patient. Given the practical impossibility of measuring it directly, esophageal pressure as an indirect variable takes on a fundamental role. The indirect measurement of pleural pressure through esophageal pressure allows the calculation of transpulmonary pressure, which becomes fundamental for the understanding and analysis of respiratory mechanics in these patients. The secure degree of positive end-expiratory pressure (PEEP) in the obese patient, which must be guided by an esophageal balloon in order to obtain a pattern optimal respiratory rate, and with the lowest transpulmonary pressure (PTP) that allows a constant protective tidal volume and better oxygenation. In the course of this paper we will discuss the physiology of esophageal pressure and its importance in the obese patient on mechanical ventilation, and we will conclude with a summary of the corresponding literature, with the technical aspects associated with its use.

REFERENCES

1. Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, et al. The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med. 2014;189(5):520-31.

2. Bigatello L, Pesenti A. Respiratory physiology for the anesthesiologist. Anesthesiology. 2019;130(6):1064-1077. Available in: http://pubs.asahq.org/anesthesiology/article-pdf/130/6/1064/455191/20190600_0-00035.pdf

3. Jubran A, Tobin MJ. Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med. 1997;155(3):906-915.

4. Cavalcanti AB, Suzumura ÉA, Laranjeira LN, Paisani DM, Damiani LP, Guimaraes HP, et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA. 2017;318(14):1335-1345.

5. Baedorf Kassis E, Loring SH, Talmor D. Osophagusdruck: Forschungswerkzeug oder klinisches Instrument? Vol. 113, Medizinische Klinik-Intensivmedizin und Notfallmedizin. Springer-Verlag; 2018,p. 13-20.

6. Baedorf Kassis E, Loring SH, Talmor D. Recruitment maneuvers: using transpulmonary pressure to help Goldilocks. Intensive Care Med. 2017;43(8):1162-1163.

7. Duque DJ, Jimenez LD, Correa LS, Rivera A. False positives in determining the proper location of the esophageal pressure catheter during occlusion test. Rev Colomb Anestesiol. 2010;38(1):125-131.

8. Yoshida T, Amato MBP, Grieco DL, Chen L, Lima CAS, Roldan R, et al. Esophageal manometry and regional transpulmonary pressure in lung injury. Am J Respir Crit Care Med. 2018;197(8):1018-1026.

9. Xia YHW, Victor MH. Correcting esophageal pressure measurements for patients undergoing mechanical ventilation. In: IFAC-PapersOnLine. Elsevier B.V.; 2021. p. 156-161.

10. Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, et al. Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med. 2016;42(9):1360-1373.

11. Regli A, Pelosi P, Malbrain MLNG. Ventilation in patients with intra-abdominal hypertension: what every critical care physician needs to know. Ann Intensive Care. 2019;9(1):52.

12. De Jong A, Cossic J, Verzilli D, Monet C, Carr J, Conseil M, et al. Impact of the driving pressure on mortality in obese and non-obese ARDS patients: a retrospective study of 362 cases. Intensive Care Med. 2018;44(7):1106-1114.

13. Behazin N, Jones SB, Cohen RI, Loring SH. Respiratory restriction and elevated pleural and esophageal pressures in morbid obesity. J Appl Physiol (1985). 2010;108(1):212-218. doi: 10.1152/japplphysiol.91356.2008.

14. Williams EC, Motta-Ribeiro GC, Vidal Melo MF. Driving pressure and transpulmonary pressure: how do we guide safe mechanical ventilation? Anesthesiology. 2019;131(1):155-163.

15. Bugedo G, Retamal J, Bruhn A. Driving pressure: a marker of severity, a safety limit, or a goal for mechanical ventilation? Crit Care. 2017;21(1):199.

16. Bime C, Fiero M, Lu Z, Oren E, Berry CE, Parthasarathy S, et al. High Positive End-Expiratory Pressure Is Associated with Improved Survival in Obese Patients with Acute Respiratory Distress Syndrome. Am J Med. 2017;130(2):207-213. doi: 10.1016/j.amjmed.2016.09.029.

17. Pirrone M, Fisher D, Chipman D, Imber DA, Corona J, Mietto C, Kacmarek RM, Berra L. Recruitment maneuvers and positive end-expiratory pressure titration in morbidly obese ICU patients. Crit Care Med. 2016;44(2):300-307.

18. Mezidi M, Daviet F, Chabert P, Hraiech S, Bitker L, Forel JM, et al. Transpulmonary pressures in obese and non-obese COVID-19 ARDS. Ann Intensive Care. 2020;10(1):129.

19. Liou J, Doherty D, Gillin T, Emberger J, Yi Y, Cardenas L, et al. Retrospective review of transpulmonary pressure guided positive end-expiratory pressure titration for mechanical ventilation in class II and III obesity. Crit Care Explor. 2022;4(5):e0690.

20. Fumagalli J, Santiago RRS, Teggia Droghi M, Zhang C, Fintelmann FJ, Troschel FM, et al. Lung recruitment in obese patients with acute respiratory distress syndrome. Anesthesiology. 2019;130(5):791-803.

21. Ortiz-Ruiz G, Dueñas-Castel C, Garay-Fernández M. Utilidad de la medición de presión esofágica en la ventilación mecánica: individualizando las variables fisiológicas. Acta Colombiana de Cuidado Intensivo. 2022;22(3):200-208.