![]() Esophageal pressure monitoring provides a window into the unique physiology of a patient and helps improve clinical decision making at the bedside. Multiple studies have illustrated the benefit of using esophageal pressures to titrate PEEP in patients with obesity and with ARDS. Although there is some spatial and positional artifact, esophageal pressures in numerous animal and human studies in healthy, obese and critically ill patients appear to be a good estimate for the "effective" pleural pressure. Measuring the esophageal pressures and adjusting PEEP to make transpulmonary pressures positive can decrease atelectasis, derecruitment of lung, and cyclical opening and closing of airways and alveoli, thus optimizing lung mechanics and oxygenation. In this setting all breaths are patient-triggered as the ventilator has no backup rate, so each breath has to be started by the patient. 2 calendar days immediately preceding the first day of increased daily minimum PEEP or FiO 2, and must be characterized by 2 calendar days of stable or decreasing daily minimum FiO 2 or PEEP values (i.e. Elevated pleural pressures may result in negative transpulmonary pressures at end expiration, leading to lung collapse. Definition of 'intrinsic PEEP' and dynamic hyperinflation Intrinsic PEEP has many synonyms, including autoPEEP ( Pepe et al, 1982 ), iPEEP and PEEPi. As the name implies it is a pressure-driven mode of ventilation. Esophageal manometry estimates pleural pressures, and can be used to differentiate the chest wall and lung (transpulmonary) contributions to the total respiratory system mechanics. With widely varying types of lung injury, body habitus and pulmonary mechanics, the use of esophageal manometry has become important for personalization and optimization of mechanical ventilation in patients with ARDS. Positive end expiratory pressure (PEEP) is an important part of a lung protective strategy but there is no standardized method to set PEEP level. ![]() Such strategies have led to significant improvements in outcomes. ![]() Ventilator management of patients with acute respiratory distress syndrome (ARDS) has been characterized by implementation of basic physiology principles by minimizing harmful distending pressures and preventing lung derecruitment.
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