Clinical application of esophageal manometry: how I do it

Abstract

Critically ill patients frequently exhibit increased chest wall weight and elevated basal end-expiratory pleural pressures secondary to edema, effusions, abdominal hypertension and other causes that may lead to derecruitment, increased lung elastance and hypoxemia. While the respiratory system driving pressure correlated with mortality in patients with ARDS [11], we believe it is inadequate due to the inherent variability and heterogeneity of the chest wall which we can directly measure using Pes. While safe levels have not been clearly defined, we have extrapolated thresholds from our understanding of the relationship between stress, strain and specific elastance, and data suggesting high ∆PL and end-inspiratory PL can bring the lung to total lung capacity and lead to lethal ventilator induced lung injury [14]. [...]esophageal balloon catheters are easily placed and interpreted.