Comparison of Esophageal and Central Venous Pressure for Estimating Transpulmonary Pressure Changes

Estimating the Transpulmonary Pressure From the Central Venous Pressure in Mechanically Ventilated Patients With Respiratory Failure

Status

Completed

Phases

Unknown

Study type

Observational

Source

ClinicalTrials.gov

Registry ID

NCT04443491

Acronym

PPLproject

Enrollment

Registered

2020-06-23

Start date

2016-05-31

Completion date

2019-03-31

Last updated

2020-06-23

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Acute Respiratory Distress Syndrome, Mechanical Ventilation

Keywords

esophageal pressure, transpulmonary pressure, central venous pressure, acute respiratory failure

Brief summary

Central venous pressure (CVP) is characterized by a low-frequency pleural-dependent as well as a high-frequency cardiac pulsatile component. The aim of the study is to compare the low-frequency component of CVP with the esophageal pressure (Pes), as surrogate of pleural pressure, to estimate trans-pulmonary pressure (PL).

Detailed description

The investigators will enroll mechanically ventilated patients admitted to the intensive care unit with the diagnosis of respiratory failure monitored with a dedicated nasogastric catheter and a central venous catheter for measuring Pes and CVP, respectively. Electrocardiogram trace, Pes, CVP and airway pressure (Paw) will be recorded at the end of inspiratory and expiratory pauses. The CVP waveforms will be analyzed off-line using a dedicated low-pass digital filter to obtain the low-frequency component of CVP (filtered CVP, fCVP). Paw, Pes and fCVP will be used to calculate PL using transpulmonary driving pressure formula (PL-Pes and PL-fCVP, respectively). The PL values obtained with fCVP and Pes will be compared to assess the correlation of the two methods.

Interventions

None listed

Study design

Observational model

COHORT

Time perspective

PROSPECTIVE

Eligibility

Sex/Gender

ALL

Age

18 Years to 90 Years

Healthy volunteers

Inclusion criteria

* adult patients receiving invasive mechanical ventilation * diagnosis of acute respiratory failure (defined as the ratio of partial oxygen pressure and fraction of inspired oxygen below 200 mmHg) * esophageal balloon catheter * central venous catheter

Exclusion criteria

* age under 18 years old * Hemodynamic instability * Esophageal diseases (varices, stenosis..) * Refusal of the patient * evidence of active air leak from the lung (pneumothorax, pneumomediastinum, existing chest tube....) * history of lung/abdominal surgery * pregnancy * severe coagulopathy

Design outcomes

Primary

Measure	Time frame	Description
Transpulmonary pressure	Within 72 hours from the starting of mechanical ventilation	Correlation and agreement between the transpulmonary pressure obtained from esophageal balloon catheter and central venous catheter

Secondary

Measure	Time frame	Description
Transpulmonary pressure in subgroups of patients	Within 72 hours from the starting of mechanical ventilation	Agreement between trans pulmonary pressure obtained with the two methods in subgroup of patients such as those with acute respiratory distress syndrome or obesity
Transpulmonary pressure in patients at risk for ventilator-induced-lung-injury	Within 72 hours from the starting of mechanical ventilation	Comparison of the transpulmonary pressure obtained with the two methods in patients at risk for ventilator-induced-lung-injury

Countries

Italy

Outcome results