Project details


Esophageal pressure in the clinical pediatric ICU setting

mechanical ventilation Transpulmonary pressure Esophageal pressure

Dr. M.C.J. Kneyber
drs. M.W. Rudolph

Nature of the research:
Prospective observational study

Fields of study:
pediatrics intensive care

Background / introduction
Mechanical ventilation is a life-saving technique but can also cause harm. Ventilator induced lung injury (VILI) describes the damage mechanical ventilation causes. Many studies have been performed to limit the VILI as much as possible. This has led to a lung protective strategy protocol. We try to set an adequate level of positive end-expiratory pressure (PEEP) to prevent the alveoli of collapsing, we ventilate with small tidal volumes of 5-7mL/kg and try to limit the positive inspiratory pressure (PIP) and plateau pressure (Pplat) to prevent barotrauma. One of the difficulties in the pediatric patient is that they differ much in height, weight and age. Therefore it is hard to make sure that the set pressures are the right pressures for that patient. Many factors are influencing this and therefore it is important to know what the pressure is on the alveoli. The airway pressure (Paw), generated by a mechanical ventilator, is in fact divided amongst two, in series arranged structures. These structures are the lungs and the surrounding chestwall, including the diaphragm, together representing the respiratory system. The intrapleural space separates the lungs from the chestwall, and thus, a pressure gradient exists across these structures separately. These pressure gradients give rise to the concept that the lung parenchyma is only affected by a fraction of the total Paw, generated by a mechanical ventilator. This pressure, applied exclusively to the lung parenchyma, is called the transpulmonary pressure (Ptp). The Ptp has proven to be a better indicator for lung strain than the Paw, generated by the mechanical ventilator. Thus, limiting the PIP and Pplat, guided by end-inspiratory Ptp measurements, may be a safer approach than the current standard. For setting the PEEP, the end-expiratory Ptp may be of help. In mechanically ventilated patients, the Paw and therefore the Ptp remain positive throughout an entire breath cycle. The esophageal catheter seems to be a good instrument to determine the right pressures for a specific patient and hereby limiting VILI.
Research question / problem definition
multiple research questions related to the esophageal catheter and the esophageal pressure are formulated: 1. What is the ideal filling volume of the esophageal balloon catheter in the pediatric patient? 2. What are the influencing factors on the esophageal pressure in children? 3. What is the difference in esophageal pressure monitoring between children and adults?
The student will participate in the research project of a PhD-candidate. The aim of the project is to support and help with the inclusion of patients, obtaining and analyzing the data and eventually the writing of a scientific report. The project will be performed at the pediatric intensive care unit of the Beatrix Children Hospital of the UMCG. The detailed workplan will be determined and discussed together with the student.
1. Mojoli F, Iotti GA, Torriglia F, Pozzi M, Volta CA, Bianzina S, Braschi A, Brochard L. In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable. Crit Care. 2016 Apr 11;20:98. doi: 10.1186/s13054-016-1278-5. PMID: 27063290; PMCID: PMC4827205.
2. Justin C Hotz, Cary T Sodetani, Jeffrey Van Steenbergen, Robinder G Khemani, Timothy W Deakers, Christopher J Newth. Measurements Obtained From Esophageal Balloon Catheters Are Affected by the Esophageal Balloon Filling Volume in Children With ARDS. Respiratory Care Feb 2018, 63 (2) 177-186; DOI: 10.4187/respcare.05685
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