Transpulmonary pressure monitoring

Lung-protective ventilation reduces ventilation-related complications, particularly by reducing the mechanical pressure and volume load on the lungs. Knowledge accumulated over recent years has proven that lung-protective ventilation is only possible by regularly adapting ventilator settings to individual lung function. But what happens if the classic prescriptions of lung-protective ventilation can no longer be met?

Adapting ventilation therapy based on transpulmonary pressure measurement is a simple, minimally invasive, and valid method that only requires the insertion of a modified gastric tube. Changes in esophageal pressure during a respiratory cycle reflect changes in pleural pressure. As the difference between ventilatory pressure and pleural pressure, the transpulmonary pressure situation indicates the extent of mechanical stress exerted on the alveoli, thus responsible for ventilation-associated lung injury. The inspiratory plateau pressure set on the turbine plays a secondary role. Studies have shown that due to the significant variability in the elasticity ratio of the lungs to the thorax, an inspiratory plateau pressure set on the ventilator leads to very different transpulmonary pressure gradients. In patients with high pleural pressure, for example due to high intra-abdominal pressure, the same inspiratory pressure can be achieved with less ventilator-associated lung injury than in patients with low pleural pressure. The expiratory transpulmonary pressure (TPP exsp) can then be adjusted by titrating the applied PEEP, because the airway pressure is related to the applied PEEP. Unlike other methods for detecting individual PEEP, this method can also be used during spontaneous breathing and during weaning. Also during weaning, measuring esophageal pressure can provide valuable information (unmasking patient-ventilator asynchrony, monitoring respiratory muscle effort, calculating intrinsic PEEP during spontaneous breathing, etc.) and helps optimize the weaning process. In this context, it is possible to determine the patient's work of breathing under assisted spontaneous breathing in an acute situation, so that the assistance required by the patient can be directly adapted to the respective lung function by means of pressure assistance.