Comparison of Changes in Pleural Pressure Swings Measured with a Fluid Filled Esophageal Catheter and Pulmonary Artery Occlusion Pressure
CCCF ePoster library. Samy L. Oct 28, 2015; 114761; P99
Dr. Laïla Samy
Dr. Laïla Samy
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Abstract
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P99


Topic: Clinical Trial


Comparison of Changes in Pleural Pressure Swings Measured with a Fluid Filled Esophageal Catheter and Pulmonary Artery Occlusion Pressure



Laïla Samy, S. Magder, P. B. Massion, P. Goldberg

Department of Critical Care Medicine, McGill University, Montreal, Canada | Department of Critical Care Medicine, McGill University, Montreal, Canada | Department of Critical Care Medicine, University of Liege, Liege, Belgium | Department of Critical Care Medicine, McGill University, Montreal, Canada

Introduction: Measurements of pleural pressure (Ppl) swings during the ventilatory cycle can aid management of ventilator settings as well as the interpretation of heart-lung interactions and can be useful when managing patients with respiratory failure[1]. Currently, Ppl is most often measured with an esophageal balloon catheter (Peo)[2]. These devices are expensive and not readily available. An inexpensive fluid filled catheter can potentially be used instead. We previously showed that ventilatory swings in pulmonary artery occlusion pressure (Ppao) can track negative pleural pressure swings during triggered ventilation [3]. Change in dPeo was greater than dPpao due to the known inspiratory increase in left heart filling. We predict that during volume control ventilation (VC) the increase in dPeo obtained with the fluid filled catheter will be concordant with dPpao, but the bias will be negative (dPpao < dPeo). During pressure support ventilation (PS), there will also be concordance during the negative deflection, and the bias again will be negative because dPao will fall less than dPeo (dPpao > dPeo), indicating filling of both right and left heart during inspiration.


Objectives: Our objective was to compare measures of ventilatory induced variations in Ppl with a fluid filled catheter compared to changes in Ppao.

Methods: We obtained consent from thirty-one patients undergoing cardiac surgery who had a pulmonary artery catheter as part of routine management. The esophageal catheter was inserted upon admission to the ICU. Patients were studied while under VC and when breathing spontaneously on PS. We collected simultaneous Peo, central venous pressure (CVP), Ppao and airway pressure and measured the peak deflection during inspiration. During VC, we studied positive deflections and during PS, negative deflections. We used a minimum of 3 measures per condition. Data are expressed as mean ± standard deviation (SD). Agreement between variables was assessed with Bland-Altman plots and identity plots.

Results: Peak changes in Peo measured with a fluid filled catheter were similar to peak changes in Ppao and CVP with both VC and PS. We obtained Bland-Altman plots and used Ppao and CVP as gold-standards measurements. As in our previous study, the bias with Ppao was negative in VC, -2.2 mmHg (confidence interval [CI] 1.4, -5.8 mmHg) compared to almost 0 with CVP 0.3 mmHg (CI 2.8, -2.1 mmHg). However, during PS the bias was negative for both Ppao, -1.8 mmHg (CI 2.1, -5.8 mmHg), and CVP, -2,2 (CI 1.4, -5.8), indicating increased filling of both right and left hearts during inspiration.

Conclusion: The fluid filled Peso catheter appeared to better represent pressure swings during ventilatory cycle with an excellent frequency response and in reality should be the gold standard. It can provide an inexpensive and easy way to measure changes in pleural pressure in mechanically ventilated patients.

References:

1. Slutsky, A.S. and V.M. Ranieri, Ventilator-induced lung injury. New England Journal of Medicine, 2013. 369(22): p. 2126-2136.

2. Akoumianaki, E., et al., The application of esophageal pressure measurement in patients with respiratory failure. American Journal of Respiratory & Critical Care Medicine, 2014. 189(5): p. 520-31.

3. Bellemare, P., P. Goldberg, and S.A. Magder, Variations in pulmonary artery occlusion pressure to estimate changes in pleural pressure. Intensive Care Medicine, 2007. 33(11): p. 2004-8.

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