Erroneous calibration of esophageal pressure in case of airway closure

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dc.contributor.authorDocci, Mattia
dc.contributor.authorBeloncle, Francois
dc.contributor.authorLesimple, Arnaud
dc.contributor.authorPiraino, Thomas
dc.contributor.authorRaimondi Cominesi, Davide
dc.contributor.authorRestivo, Andrea
dc.contributor.authorSousa, Mayson L. A.
dc.contributor.authorRezoagli, Emanuele
dc.contributor.authorMercat, Alain
dc.contributor.authorRichard, Jean-Christophe
dc.contributor.authorBrochard, Laurent
dc.date.accessioned2025-06-13T20:44:43Z
dc.date.available2025-06-13T20:44:43Z
dc.date.issued2025-05-02
dc.date.updated2025-06-01T03:29:17Z
dc.description.abstractAbstract Airway closure results in a lack of communication between proximal and distal airways unless the airway pressure (Paw) overcomes the airway opening pressure (AOP). This has been described in patients undergoing mechanical ventilation with acute respiratory distress syndrome, obesity, hydrostatic pulmonary edema and during cardiopulmonary resuscitation. In these categories of patients, esophageal pressure (Pes) can guide the personalization of mechanical ventilation and calibration of the esophageal balloon is necessary to obtain reliable Pes measurements. The impact of airway closure has never been envisaged. This study investigated the impact of airway closure on the calibration of the esophageal balloon by the ∆Paw/∆Pes following a positive pressure occlusion test during passive mechanical ventilation. The calibration test was performed in twelve human cadavers with airway closure at end-expiration at different levels of positive end-expiratory pressure (PEEP) and at end-inspiration. The ∆Paw/∆Pes measured at end-expiration and at end-inspiration were significantly different when total PEEP was lower than AOP (estimated means 0.42 [0.40; 0.44] vs. 0.95 [0.92; 0.97], P < 0.001), while this difference was not observed when total PEEP was higher than AOP (estimated means 0.99 [0.92; 1.05] vs. 0.99 [0.92; 1.06], P = 0.854). These results were corroborated by observations during esophageal balloon calibration in two patients requiring Pes monitoring for clinical management. In case of airway closure, compression of the chest is not fully transmitted to the airways. This can lead to a conspicuous underestimation of the ∆Paw/∆Pes and poor reliability of this monitoring technique when the test takes place below AOP. Our results favor a positive pressure occlusion test performed during an end-inspiratory occlusion as the new standard of operative procedures for positioning and calibrating the esophageal balloon.
dc.identifier.citationCritical Care. 2025 May 02;29(1):178
dc.identifier.doi10.1186/s13054-025-05416-5
dc.identifier.urihttp://hdl.handle.net/1993/39116
dc.language.isoeng
dc.language.rfc3066en
dc.publisherBMC
dc.rights.holderThe Author(s)
dc.subjectEsophageal pressure
dc.subjectCalibration
dc.subjectAirway closure
dc.subjectAirway opening pressure
dc.subjectPositive pressure occlusion test
dc.subjectBaydur test
dc.subjectEnd‑expiratory occlusion
dc.subjectEnd‑inspiratory occlusion
dc.subjectAcute respiratory distress syndrome
dc.subjectARDS
dc.titleErroneous calibration of esophageal pressure in case of airway closure
dc.typeJournal Article
local.author.affiliationRady Faculty of Health Sciences::College of Rehabilitation Sciences
oaire.citation.startPage178
oaire.citation.titleCritical Care
oaire.citation.volume29
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