Estimation of muscle pressure from the measurement of occlusion pressure in invasive mechanical ventilation
Abstract
Assisted mechanical ventilation must be optimized to maintain adequate respiratory effort. Esophageal manometry is the gold standard for monitoring respiratory effort, as it assesses the pressure generated by the inspiratory muscles. However, this tool is invasive and rarely used in clinical practice. Bertoni et al. have suggested that, during an end-expiratory occlusion maneuver, the deflection of airway pressure caused by the patient's effort against an occluded valve (ΔPocc) enables the estimation of muscle pressure in a simple and non-invasive way. Currently, most ventilators can apply occlusion maneuvers in controlled and spontaneous modes. The objective of this study is to describe the procedure for measuring and calculating muscle pressure from ΔPocc.
References
Mauri T, Cambiaghi B, Spinelli E, Langer T, Grasselli G. Spontaneous breathing: a double-edged sword to handle with care. Ann Transl Med. 2017 Jul;5(14):292.
Schepens T, Dres M, Heunks L, Goligher EC. Diaphragm-protective mechanical ventilation. Curr Opin Crit Care. 2019;25(1):77-85.
Bertoni M, Spadaro S, Goligher EC. Monitoring Patient Respiratory Effort During Mechanical Ventilation: Lung and Diaphragm-Protective Ventilation. Crit Care.2020;24(1):106.
Brochard L, Slutsky A, Pesenti A. Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure. Am J Respir Crit Care Med. 2017;195(4):438-442.
Pham T, Telias I, Beitler JR. Esophageal Manometry.Respir Care 2020;65(6):772–792.
Bertoni M, Telias I, Urner M, Long M, Del Sorbo L, Fan E, 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(1):346.
Kallet RH, Phillips JS, Summers TJ, Burns G, Pangilinan L, Carothers L, et al. Expiratory pause maneuver to assess inspiratory muscle pressure during assisted mechanical ventilation: bench study. Respcare. 2021;66(11):1649-1656.
Dianti J, Bertoni M, Goligher EC. Monitoring patient-ventilator interaction by an end-expiratory occlusion maneuver. Intensive Care Med. 2020;46(12):2338-2341.
Goligher EC, Jonkman AH, Dianti J, Vaporidi K, Beitler JR, Patel BK, et al. Clinical strategies for implementing lung and diaphragm‑protective ventilation: avoiding insufficient and excessive effort. Intensive Care Med. 2020;46:2314–2326.
