Esophageal pressure (Pes) monitoring is a minimally invasive advanced respiratory monitoring method with the potential to guide ventilation support management. Pes monitoring enables the separation of lung and chest wall mechanics and estimation of transpulmonary pressure, which is recognized as an important risk factor for lung injury during both spontaneous breathing and mechanical ventilation. Appropriate balloon positioning, calibration, and measurement techniques are important to avoid inaccurate results. Both the approach of using absolute expiratory Pes values and the approach based on tidal Pes difference have shown promising results for ventilation adjustments, with the potential to decrease the risk of ventilator-induced lung injury.

Department of Anesthesiology and Intensive Care Medicine Charles University Faculty of Medicine in Hradec Kralove University Hospital Hradec Kralove Sokolska 581 500 05 Hradec Kralove Czech Republic

See more in PubMed

Mauri T., Yoshida T., Bellani G., Goligher E.C., Carteaux G., Rittayamai N., Mojoli F., Chiumello D., Piquilloud L., Grasso S., et al. PLeUral pressure working Group (PLUG—Acute Respiratory Failure section of the European Society of Intensive Care Medicine). Esophageal and transpulmonary pressure in the clinical setting: Meaning, usefulness and perspectives. Intensive Care Med. 2016;42:1360–1373. doi: 10.1007/s00134-016-4400-x. PubMed DOI

Gattinoni L., Giosa L., Bonifazi M., Pasticci I., Busana M., Macri M., Romitti F., Vassalli F., Quintel M. Targeting transpulmonary pressure to prevent ventilator-induced lung injury. Expert Rev. Respir. Med. 2019;13:737–746. doi: 10.1080/17476348.2019.1638767. PubMed DOI

Sahetya S.K., Brower R.G. The promises and problems of transpulmonary pressure measurements in acute respiratory distress syndrome. Curr. Opin. Crit. Care. 2016;22:7–13. doi: 10.1097/MCC.0000000000000268. PubMed DOI PMC

Gattinoni L., Carlesso E., Caironi P. Stress and strain within the lung. Curr. Opin. Crit. Care. 2012;18:42–47. doi: 10.1097/MCC.0b013e32834f17d9. PubMed DOI

Talmor D., Sarge T., Malhotra A., O’Donnell C.R., Ritz R., Lisbon A., Novack V., Loring S.H. Mechanical ventilation guided by esophageal pressure in acute lung injury. N. Engl. J. Med. 2008;359:2095–2104. doi: 10.1056/NEJMoa0708638. PubMed DOI PMC

Yoshida T., Grieco D.L., Brochard L., Fujino Y. Patient self-inflicted lung injury and positive end-expiratory pressure for safe spontaneous breathing. Curr. Opin. Crit. Care. 2020;26:59–65. doi: 10.1097/MCC.0000000000000691. PubMed DOI

Mauri T., Bellani G., Confalonieri A., Tagliabue P., Turella M., Coppadoro A., Citerio G., Patroniti N., Pesenti A. Topographic distribution of tidal ventilation in acute respiratory distress syndrome: Effects of positive end-expiratory pressure and pressure support. Crit. Care Med. 2013;41:1664–1673. doi: 10.1097/CCM.0b013e318287f6e7. PubMed DOI

Yoshida T., Amato M.B.P., Grieco D.L., Chen L., Lima C.A.S., Roldan R., Morais C.C.A., Gomes S., Costa E.L.V., Cardoso P.F.G., et al. Esophageal Manometry and Regional Transpulmonary Pressure in Lung Injury. Am. J. Respir. Crit. Care Med. 2018;197:1018–1026. doi: 10.1164/rccm.201709-1806OC. PubMed DOI

Mietto C., Malbrain M.L., Chiumello D. Transpulmonary pressure monitoring during mechanical ventilation: A bench-to-bedside review. Anaesthesiol. Intensive Ther. 2015;8:27–37. doi: 10.5603/AIT.a2015.0065. PubMed DOI

Gattinoni L., Chiumello D., Carlesso E., Valenza F. Bench-to-bedside review: Chest wall elastance in acute lung injury/acute respiratory distress syndrome patients. Crit. Care. 2004;8:350–355. doi: 10.1186/cc2854. PubMed DOI PMC

Grieco D.L., Chen L., Brochard L. Transpulmonary pressure: Importance and limits. Ann. Transl. Med. 2017;5:285. doi: 10.21037/atm.2017.07.22. PubMed DOI PMC

Mojoli F., Torriglia F., Orlando A., Bianchi I., Arisi E., Pozzi M. Technical aspects of bedside respiratory monitoring of transpulmonary pressure. Ann. Transl. Med. 2018;6:377. doi: 10.21037/atm.2018.08.37. PubMed DOI PMC

Mojoli F., Chiumello D., Pozzi M., Algieri I., Bianzina S., Luoni S., Volta C.A., Braschi A., Brochard L. Esophageal pressure measurements under different conditions of intrathoracic pressure. An in vitro study of second generation balloon catheters. Minerva Anestesiol. 2015;81:855–864. PubMed

Niknam J., Chandra A., Adams A.B., Nahum A., Ravenscraft S.A., Marini J.J. Effect of a nasogastric tube on esophageal pressure measurement in normal adults. Chest. 1994;106:137–141. doi: 10.1378/chest.106.1.137. PubMed DOI

Mojoli F., Iotti G.A., Torriglia F., Pozzi M., Volta C.A., Bianzina S., Braschi A., Brochard L. In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable. Crit. Care. 2016;20:98. doi: 10.1186/s13054-016-1278-5. PubMed DOI PMC

Yang Y.L., He X., Sun X.M., Chen H., Shi Z.H., Xu M., Chen G.Q., Zhou J.X. Optimal esophageal balloon volume for accurate estimation of pleural pressure at end-expiration and end-inspiration: An in vitro bench experiment. Intensive Care Med. Exp. 2017;5:35. doi: 10.1186/s40635-017-0148-z. PubMed DOI PMC

Sun X.M., Chen G.Q., Huang H.W., He X., Yang Y.L., Shi Z.H., Xu M., Zhou J.X. Use of esophageal balloon pressure-volume curve analysis to determine esophageal wall elastance and calibrate raw esophageal pressure: A bench experiment and clinical study. BMC Anesthesiol. 2018;18:21. doi: 10.1186/s12871-018-0488-6. PubMed DOI PMC

Kassis E.B., Talmor D. Clinical application of esophageal manometry: How I do it. Crit. Care. 2021;25:6. doi: 10.1186/s13054-020-03453-w. PubMed DOI PMC

Jiang J., Su L., Cheng W., Wang C., Rui X., Tang B., Zhang H., He H., Long Y. The calibration of esophageal pressure by proper esophageal balloon filling volume: A clinical study. Front. Med. 2022;9:986982. doi: 10.3389/fmed.2022.986982. PubMed DOI PMC

Kumaresan A., Gerber R., Mueller A., Loring S.H., Talmor D. Effects of Prone Positioning on Transpulmonary Pressures and End-expiratory Volumes in Patients without Lung Disease. Anesthesiology. 2018;128:1187–1192. doi: 10.1097/ALN.0000000000002159. PubMed DOI

Beitler J.R., Sarge T., Banner-Goodspeed V.M., Gong M.N., Cook D., Novack V., Loring S.H., Talmor D., EPVent-2 Study Group Effect of Titrating Positive End-Expiratory Pressure (PEEP) With an Esophageal Pressure-Guided Strategy vs an Empirical High PEEP-Fio2 Strategy on Death and Days Free From Mechanical Ventilation Among Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2019;321:846–857. doi: 10.1001/jama.2019.0555. PubMed DOI PMC

Sarge T., Baedorf-Kassis E., Banner-Goodspeed V., Novack V., Loring S.H., Gong M.N., Cook D., Talmor D., Beitler J.R., EPVent-2 Study Group Effect of Esophageal Pressure-guided Positive End-Expiratory Pressure on Survival from Acute Respiratory Distress Syndrome: A Risk-based and Mechanistic Reanalysis of the EPVent-2 Trial. Am. J. Respir. Crit. Care Med. 2021;204:1153–1163. doi: 10.1164/rccm.202009-3539OC. PubMed DOI PMC

Amato M.B., Meade M.O., Slutsky A.S., Brochard L., Costa E.L., Schoenfeld D.A., Stewart T.E., Briel M., Talmor D., Mercat A., et al. Driving pressure and survival in the acute respiratory distress syndrome. N. Engl. J. Med. 2015;372:747–755. doi: 10.1056/NEJMsa1410639. PubMed DOI

Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators. Cavalcanti A.B., Suzumura É.A., Laranjeira L.N., Paisani D.M., Damiani L.P., Guimarães H.P., Romano E.R., Regenga M.M., Taniguchi L.N.T., et al. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2017;318:1335–1345. doi: 10.1001/jama.2017.14171. PubMed DOI PMC

Gattinoni L., Marini J.J. In search of the Holy Grail: Identifying the best PEEP in ventilated patients. Intensive Care Med. 2022;48:728–731. doi: 10.1007/s00134-022-06698-x. PubMed DOI PMC

Grasso S., Terragni P., Birocco A., Urbino R., Del Sorbo L., Filippini C., Mascia L., Pesenti A., Zangrillo A., Gattinoni L., et al. ECMO criteria for influenza A (H1N1)-associated ARDS: Role of transpulmonary pressure. Intensive Care Med. 2012;38:395–403. doi: 10.1007/s00134-012-2490-7. PubMed DOI

Bugedo G., Retamal J., Bruhn A. Driving pressure: A marker of severity, a safety limit, or a goal for mechanical ventilation? Crit. Care. 2017;21:199. doi: 10.1186/s13054-017-1779-x. PubMed DOI PMC

Pelosi P., Ball L., Barbas C.S.V., Bellomo R., Burns K.E.A., Einav S., Gattinoni L., Laffey J.G., Marini J.J., Myatra S.N., et al. Personalized mechanical ventilation in acute respiratory distress syndrome. Crit. Care. 2021;25:250. doi: 10.1186/s13054-021-03686-3. PubMed DOI PMC

Goligher E.C., Dres M., Patel B.K., Sahetya S.K., Beitler J.R., Telias I., Yoshida T., Vaporidi K., Grieco D.L., Schepens T., et al. Lung- and Diaphragm-Protective Ventilation. Am. J. Respir. Crit. Care Med. 2020;202:950–961. doi: 10.1164/rccm.202003-0655CP. PubMed DOI PMC

Carteaux G., Parfait M., Combet M., Haudebourg A.F., Tuffet S., Mekontso Dessap A. Patient-Self Inflicted Lung Injury: A Practical Review. J. Clin. Med. 2021;10:2738. doi: 10.3390/jcm10122738. PubMed DOI PMC

Bertoni M., Telias I., Urner M., Long M., Del Sorbo L., Fan E., Sinderby C., Beck J., Liu L., Qiu H., et al. A novel non-invasive method to detect excessively high respiratory effort and dynamic transpulmonary driving pressure during mechanical ventilation. Crit. Care. 2019;23:346. doi: 10.1186/s13054-019-2617-0. PubMed DOI PMC