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Determinants of the esophageal-pleural pressure relationship in humans.

人类食管-胸膜压力关系的决定因素。

  • 影响因子:2.76
  • DOI:10.1152/japplphysiol.00587.2019
  • 作者列表:"Pasticci I","Cadringher P","Giosa L","Umbrello M","Formenti P","Macri MM","Busana M","Bonifazi M","Romitti F","Vassalli F","Cressoni M","Quintel M","Chiumello D","Gattinoni L
  • 发表时间:2020-01-01
Abstract

:Esophageal pressure has been suggested as adequate surrogate of the pleural pressure. We investigate after lung surgery the determinants of the esophageal and intrathoracic pressures and their differences. The esophageal pressure (through esophageal balloon) and the intrathoracic/pleural pressure (through the chest tube on the surgery side) were measured after surgery in 28 patients immediately after lobectomy or wedge resection. Measurements were made in the nondependent lateral position (without or with ventilation of the operated lung) and in the supine position. In the lateral position with the nondependent lung, collapsed or ventilated, the differences between esophageal and pleural pressure amounted to 4.4 ± 1.6 and 5.1 ± 1.7 cmH2O. In the supine position, the difference amounted to 7.3 ± 2.8 cmH2O. In the supine position, the estimated compressive forces on the mediastinum were 10.5 ± 3.1 cmH2O and on the iso-gravitational pleural plane 3.2 ± 1.8 cmH2O. A simple model describing the roles of chest, lung, and pneumothorax volume matching on the pleural pressure genesis was developed; modeled pleural pressure = 1.0057 × measured pleural pressure + 0.6592 (r2 = 0.8). Whatever the position and the ventilator settings, the esophageal pressure changed in a 1:1 ratio with the changes in pleural pressure. Consequently, chest wall elastance (Ecw) measured by intrathoracic (Ecw = ΔPpl/tidal volume) or esophageal pressure (Ecw = ΔPes/tidal volume) was identical in all the positions we tested. We conclude that esophageal and pleural pressures may be largely different depending on body position (gravitational forces) and lung-chest wall volume matching. Their changes, however, are identical.NEW & NOTEWORTHY Esophageal and pleural pressure changes occur at a 1:1 ratio, fully justifying the use of esophageal pressure to compute the chest wall elastance and the changes in pleural pressure and in lung stress. The absolute value of esophageal and pleural pressures may be largely different, depending on the body position (gravitational forces) and the lung-chest wall volume matching. Therefore, the absolute value of esophageal pressure should not be used as a surrogate of pleural pressure.

摘要

: 食管压力被认为是胸膜压力的充分替代。我们研究了肺手术后食管和胸内压力的决定因素及其差异。对 28 例肺叶切除或楔形切除患者术后即刻食管压 (通过食管球囊) 和胸内/胸膜压 (通过手术侧胸管) 进行测量。在非依赖性侧卧位 (无或有手术肺通气) 和仰卧位进行测量。在侧卧位,非依赖性肺,塌陷或通气时,食管和胸膜压差分别为 4.4 ± 1.6 和 5.1 ± 1.7 cmH2O。在仰卧位,差异达 7.3 ± 2.8 cmH2O。在仰卧位,估计对纵隔的压缩力为 10.5 ± 3.1 cmH2O,对等重力胸膜平面的压缩力为 3.2 ± 1.8 cmH2O。建立了一个描述胸、肺、气胸体积匹配对胸膜压力发生作用的简单模型; 模拟胸膜压力 = 1.0057 × 测量胸膜压力 + 0.6592 (r2 = 0.8)。无论位置和呼吸机设置如何,食管压力随胸膜压力的变化呈 1:1 比变化。因此,在我们测试的所有位置中,通过胸内 (Ecw = Δ ppl/潮气量) 或食管压力 (Ecw = Δ pes/潮气量) 测量的胸壁弹性 (Ecw) 是相同的。我们得出结论,食管和胸膜压力可能在很大程度上不同,这取决于体位 (重力) 和肺-胸壁容积匹配。然而,他们的变化是相同的。新的 & 值得注意的食管和胸膜压力变化发生在 1:1 的比例,完全证明使用食管压力来计算胸壁弹性以及胸膜压力和肺应力的变化是合理的。食管和胸膜压力的绝对值可能有很大差异,这取决于身体位置 (重力) 和肺-胸壁体积匹配。因此,食管压力的绝对值不应作为胸膜压力的替代。

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关键词: 暂无
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影响因子:3.94
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DOI:10.1016/j.taap.2019.114847
作者列表:["Bernstein DM","Toth B","Rogers RA","Kling DE","Kunzendorf P","Phillips JI","Ernst H"]

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影响因子:4.04
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DOI:10.1042/BST20191010
作者列表:["Zaragosi LE","Deprez M","Barbry P"]

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