返回

Test your IntelliVence (Vol 20 Issue 3)

文章

作者: Jean-Michel Arnal, Senior Intensivist, Hopital Sainte Musse, Toulon, France

日期: 04.12.2023

What are the oscillations on the P-V curve?  Keep reading for the full story!

Test your IntelliVence (Vol 20 Issue 3)

Question

A 74-year-old woman with a medical history of breast cancer treated by chemotherapy was admitted to the ICU for severe ARDS attributed to pneumonia. An esophageal catheter was inserted and a P-V curve was performed.

What are the small oscillations visible on the inflation and deflation limbs of the P-V curves shown below?

 

Screenshot of airway PV curve
Figure 1: Airway pressure-volume curve
Screenshot of airway PV curve
Figure 1: Airway pressure-volume curve
Screenshot of esophageal PV curve
Figure 2: Esophageal pressure-volume curve
Screenshot of esophageal PV curve
Figure 2: Esophageal pressure-volume curve
Screenshot of transpulmonary pressure-volume curve
Figure 3: Transpulmonary pressure-volume curve
Screenshot of transpulmonary pressure-volume curve
Figure 3: Transpulmonary pressure-volume curve

Answer

The small oscillations correspond with the transmission of cardiogenic oscillations. Note that the oscillations are greater on the esophageal pressure-volume curve and the transpulmonary pressure-volume curve. This is in line with the waveforms that show greater oscillations on esophageal pressure measurements when compared to airway pressure (see Fig. 4 below).

Screenshot showing airway pressure, flow, Pes, and Ptranspulm waveforms
Figure 4: Paw, Flow, Pes, and Ptranspulm waveforms
Screenshot showing airway pressure, flow, Pes, and Ptranspulm waveforms
Figure 4: Paw, Flow, Pes, and Ptranspulm waveforms