A novel method for transpulmonary pressure estimation using fluctuation of central venous pressure

The objective of the study is to develop a correction method for estimating the change in pleural pressure ( ΔPpl) and plateau transpulmonary pressure (PL) by using the change in central venous pressure ( ΔCVP). Seven children (aged<  15 years) with acute respiratory failure (PaO2/FIO2 <  300 mmHg), who were paralyzed and mechanically ventilated with a PEEP of<  10 cmH2O and had central venous catheters and esophageal balloon catheters placed for clinical purposes, were enrolled prospectively. We compared change in esophageal pressure ( ΔPes), ΔCVP, and ΔPpl calculated using a corrected ΔCVP (cΔCVP-derived ΔPpl). cΔCVP-derived ΔPpl was calculated as κ × ΔCVP, where κ was the ratio of the change in airway pressure (ΔPaw) to ΔCVP during the occlusion test. cΔCVP-derived ΔPpl correlated better than ΔCVP with ΔPes (R2 = 0.48, p = 0.08 vs. R2 = 0.14, p = 0.4) with lesser bias and precision in Bland–Altman analysis. The plateau PL calculated using the c ΔCVP-derived ΔPpl (17.6 ± 2.6 cmH2O) correlated well with the ΔPes-derived plateau PL (18.1  ± 2.3 cmH2O) (R2 = 0.90, p = 0.001). Our correction method can estimate ΔPpl and plateau PL from ΔCVP with a reasonable accuracy in paralyzed and mechanically ventilated pediatric patients with respiratory failure.
Source: Journal of Clinical Monitoring and Computing - Category: Information Technology Source Type: research