Do newer monitors of exhaled gases, mechanics, and esophageal pressure add value?
The current understanding of lung mechanics and ventilator-induced lung injury suggests that patients who have acute respiratory distress syndrome should be ventilated in such a way as to minimize alveolar over-distension and repeated alveolar collapse. Clinical trials have used such lung protective strategies and shown a reduction in mortality; however, there is data that these "one-size fits all" strategies do not work equally well in all patients. This article reviews other methods that may prove useful in monitoring for potential lung injury: exhaled breath condensate, pressure-volume curves, and esophageal manometry. The authors explore the concepts, benefits, difficulties, and relevant clinical trials of each.
Owens
Robert L
RL
Department of Medicine, Pulmonary and Critical Care Unit, Cox 2, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Stigler
William S
WS
Hess
Dean R
DR
D001944:Breath Tests; D004947:Esophagus / Q000502:physiology*; D006801:Humans; D008365:Manometry; D008991:Monitoring, Physiologic; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology* / Q000628:therapy*; D015656:Respiratory Mechanics / Q000502:physiology*