This intubated patient is ventilated in pressure-support mode. What is the explanation for the sudden increase in esophageal pressure?
Answer: The large increase in esophageal pressure that is not synchronous with the mechanical ventilation is caused by an esophageal contraction due to peristalsis. Esophageal contractions occur in both passive and spontaneously breathing patients. They can occur spontaneously or be provoked by catheter placement or balloon inflation. The pressure reached during the contraction usually exceeds 50 cmH2O for a duration of 3–20 seconds. In the case of an esophageal contraction, esophageal pressure measurement should be interrupted until esophageal pressure returns to its baseline value.
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