title: Measurement of esophageal pressure at bedside: pros and cons.
abstract: OBJECTIVE
  Esophageal pressure measurement well estimates pleural pressure. The interpretation of absolute values is often debated for various reasons, but the changes in pressure measured are considered very accurate provided that a number of precautions are taken. The information provided by these measurements is unique in nature and has an enormous potential to influence management. It allows to study the exact influence of the chest wall and to determine the real lung distending pressure. It is also the only way to quantify respiratory muscle activity and the work of breathing.
  
  
  RESULTS
  The application of esophageal pressure monitoring potentially covers a large field, especially for what concerns mechanical ventilation. This goes from the acute phase of the acute respiratory distress syndrome (ARDS) to weaning and patient-ventilator interactions. During ARDS, recent findings indicate that this measurement may help titrating the level of positive end-expiratory pressure or to determine the well tolerated upper limit of airway pressure.
  
  
  CONCLUSIONS
  Application of esophageal pressure monitoring is limited by technical issues, the need for background physiological knowledge and the fact that very few studies have assessed a direct influence of this measurement on patients' outcome. The technique is underused in everyday practice.
authors.affiliation: St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
mesh_terms: D000328:Adult; D000403:Airway Resistance; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D010994:Pleura / Q000503:physiopathology*; D011175:Positive-Pressure Respiration; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology*; D013990:Tidal Volume; D014939:Work of Breathing