esophageal pressure while on ventilator

 Q: Esophageal pressure (PES) is an estimate of? (select one) 

A) Transpulmonary pressure 

B) Airway pressure 

 C) Pleural pressure 

D) All of the above 

 Answer: C

Esophageal pressure (PES) is a good surrogate estimate of pleural pressure. It is measured via an esophageal balloon catheter. It provides an essential value to compute in the calculation of transpulmonary pressure formula: 

Transpulmonary pressure = airway pressure - pleural pressure 

Applying Positive-End-Expiratory-Pressure (PEEP) in adjustment with pleural pressure to 

• keep an end-expiratory transpulmonary pressure between 0 to 10 cm H2O prevents cyclic alveolar collapse, and 
•  maintaining an end-inspiratory transpulmonary pressure ≤ 25 cm H2O reduces alveolar overdistension

Despite its efficacy has been demonstrated in few trials, clinically it is found to be cumbersome at the bedside to use routinely due to a need for extra necessary equipment as well as trained staff.

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References:

1. Talmor D, Sarge T, Malhotra A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med 2008; 359:2095. 

2. Beitler JR, Sarge T, Banner-Goodspeed VM, et al. Effect of Titrating Positive End-Expiratory Pressure (PEEP) With an Esophageal Pressure-Guided Strategy vs an Empirical High PEEP-Fio2 Strategy on Death and Days Free From Mechanical Ventilation Among Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA 2019; 321:846. 

3. Bernard GR. PEEP guided by esophageal pressure--any added value? N Engl J Med 2008; 359:2166.