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 Technologies

Transpulmonary pressure. Better understand respiratory system mechanics

Esophageal pressure catheter Nutrivent

Insights from the inside. Esophageal pressure measurement

Esophageal pressure (Pes) measurement is a minimally invasive monitoring method, which enables us to determine the transpulmonary pressure.

The most common way to measure Pes is using an air-filled balloon integrated into an esophageal catheter.

Ventilator display showing esophageal pressure (Pes), and transpulmonary pressures (Ptranspulm) as a waveform. Ventilator display showing esophageal pressure (Pes), and transpulmonary pressures (Ptranspulm) as a waveform.

Seeing is believing! Pes and Ptranspulm on the display

After you have connected the esophageal balloon catheter to the auxiliary port and confirmed the correct placement, the ventilator display shows esophageal pressure (Pes) and transpulmonary pressure (Ptranspulm) as a waveform.

You can measure static Ptranspulm using inspiratory and expiratory hold maneuvers.

Doctor with a patient

Combined efforts! Assess lung recruitability

For assessing recruitability and performing recruitment maneuvers, transpulmonary pressure can also be used in combination with the P/V Tool® Pro.

E-book 13 Expert Tips

Free e-book

13 Expert Tips. Esophageal pressure measurement

Clinically proven recommendations about what to do and what to avoid when using esophageal pressure in ARDS patients.

Statistic graphic: Talmor D. N Engl J Med. 2008 Nov 13;359(20):2095-104

What are the benefits? A look at the evidence

  • PEEP setting based on transpulmonary pressure improved compliance and oxygenation in ARDS patients (Talmor D, Sarge T, Malhotra A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med. 2008;359(20):2095-2104. doi:10.1056/NEJMoa07086381​).
  • Targeting positive transpulmonary pressure improved elastance and driving pressures, and may be associated with improved 28-day mortality (Baedorf Kassis E, Loring SH, Talmor D. Mortality and pulmonary mechanics in relation to respiratory system and transpulmonary driving pressures in ARDS. Intensive Care Med. 2016;42(8):1206-1213. doi:10.1007/s00134-016-4403-72​).
  • Transpulmonary pressure measurement can avoid the use of ECMO in the most severe patients (Grasso S, Terragni P, Birocco A, et al. ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure. Intensive Care Med. 2012;38(3):395-403. doi:10.1007/s00134-012-2490-73​).
  • A ventilation strategy guided by transpulmonary pressure may increase the proportion of patients with severe ARDS successfully weaned from ECMO (Wang R, Sun B, Li X, et al. Mechanical Ventilation Strategy Guided by Transpulmonary Pressure in Severe Acute Respiratory Distress Syndrome Treated With Venovenous Extracorporeal Membrane Oxygenation. Crit Care Med. 2020;48(9):1280-1288. doi:10.1097/CCM.00000000000044454​).
  • Pes measurement is the gold-standard technique to assess respiratory effort and work of breathing (Bertoni M, Spadaro S, Goligher EC. Monitoring Patient Respiratory Effort During Mechanical Ventilation: Lung and Diaphragm-Protective Ventilation. Crit Care. 2020;24(1):106. Published 2020 Mar 24. doi:10.1186/s13054-020-2777-y5​).
Graphic illustration: student holding certificate in his hand

Good to know! Transpulmonary pressure training resources

Watch this short demonstration to learn how to use transpulmonary pressure measurement to set PEEP in mechanically ventilated patients more accurately.

How to set PEEP with transpulmonary pressure

Watch this short demonstration to learn how to use transpulmonary pressure measurement to set PEEP more accurately.

Inserting an esophageal balloon catheter into a patient

It’s all a question of technique! Inserting an esophageal balloon catheter

Consumables

We offer esophageal ballon catheters from Cooper Surgical and naso-gastic catheters from NutriVent.

Availability

Transpulmonary pressure measurement is a standard feature on the HAMILTON-C6 and the HAMILTON-G5/S1.

Mechanical ventilation guided by esophageal pressure in acute lung injury.

Authors: Daniel Talmor, Todd Sarge, Atul Malhotra, Carl R O'Donnell, Ray Ritz, Alan Lisbon, Victor Novack, Stephen H Loring

Mortality and pulmonary mechanics in relation to respiratory system and transpulmonary driving pressures in ARDS.

Authors: Elias Baedorf Kassis, Stephen H Loring, Daniel Talmor

ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure.

Authors: Salvatore Grasso, Pierpaolo Terragni, Alberto Birocco, Rosario Urbino, Lorenzo Del Sorbo, Claudia Filippini, Luciana Mascia, Antonio Pesenti, Alberto Zangrillo, Luciano Gattinoni, V Marco Ranieri

Mechanical Ventilation Strategy Guided by Transpulmonary Pressure in Severe Acute Respiratory Distress Syndrome Treated With Venovenous Extracorporeal Membrane Oxygenation.

Authors: Rui Wang, Bing Sun, Xuyan Li, Xiao Tang, Hangyong He, Ying Li, Xue Yuan, Haichao Li, Huiwen Chu, Zhaohui Tong

Monitoring Patient Respiratory Effort During Mechanical Ventilation: Lung and Diaphragm-Protective Ventilation.

Authors: Michele Bertoni, Savino Spadaro, Ewan C Goligher