Oesophageal balloon calibration during pressure support ventilation: a proof of concept study
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ORIGINAL RESEARCH
Oesophageal balloon calibration during pressure support ventilation: a proof of concept study Gianmaria Cammarota1 · Federico Verdina2 · Erminio Santangelo2 · Gianluigi Lauro2 · Ester Boniolo2 · Riccardo Tarquini2 · Elena Spinelli3 · Marta Zanoni1 · Eugenio Garofalo4 · Andrea Bruni4 · Antonio Pesenti3 · Francesco Della Corte2 · Paolo Navalesi4 · Rosanna Vaschetto2 · Tommaso Mauri3 Received: 19 September 2019 / Accepted: 28 November 2019 © Springer Nature B.V. 2019
Abstract Oesophageal balloon calibration improves the oesophageal pressure (Pes) assessment during invasive controlled mechanical ventilation. The primary aim of the present investigation was to ascertain the feasibility of oesophageal balloon calibration during pressure support ventilation (PSV). Secondarily, the calibrated Pes (Pescal) was compared to uncalibrated one acquired at 4 ml-filling volume (PesV4), as per manufacturer recommendation. After a naso-gastric tube equipped with oesophageal balloon was correctly positioned in 21 adult patients undergoing invasive volume-controlled ventilation (VCV) for acute hypoxemic respiratory failure, the balloon was progressively inflated, applying a series of end-inspiratory and end-expiratory holds at each filling volume during VCV and PSV. Upon optimal balloon filling volume ( Vbest) was identified, P escal was computed by correcting the Pes measured at V best for the oesophageal wall pressure elicited at same filling volume. Finally, end-expiratory and end-inspiratory PesV4 were recorded too. A total of 42 calibrations, 21 per ventilatory mode, were performed. Vbest was 1.9 ± 1.6 ml in VCV and 1.7 ± 1.6 ml in PSV (p = 0.5217). P esV4 was overestimated compared to P escal at end-expiration and end-inspiration (p 5 µg/kg/min or norepinephrine > 0.1 µg/kg/min to maintain systolic arterial blood pressure ≥ 90 mmHg), (6) previous inclusion in another research protocol.
2.2 Protocol First, during deep sedation (Richmond Agitation Sedation Scale score of − 5), with patients in VCV mode, a special gastric feeding tube equipped with oesophageal balloon
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Journal of Clinical Monitoring and Computing
(Nutrivent Sidam, Mirandola, MO, Italy), previously deflated and secured with a three-way stopcock, was inserted through the nose/mouth till the stomach was reached. Afterwards, the balloon was connected through polyethylene tubes to a pressure transducer box (KleisTEK Engineering, Bari, Italy). The balloon was inflated at a volume of 4 ml, the intra-gastric position was confirmed by positive deflection during gentle external manual epigastric compression. Subsequently, the catheter was slowly withdrawn into the mid-lower third of oesophagus, as indicated by the appearance of cardiac artefacts on the oesophageal pressure waveform [4]. The calibration procedure was started to identify V best: the oesophageal balloon was progressively inflated with increasing volume from 0 to 8 ml, assuring a complete deflation before each inflation volume. At each volume, static end-expiratory and
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