title: The promises and problems of transpulmonary pressure measurements in acute respiratory distress syndrome.
abstract: OBJECTIVE
  The optimal strategy for assessing and preventing ventilator-induced lung injury in the acute respiratory distress syndrome (ARDS) is controversial. Recent investigative efforts have focused on personalizing ventilator settings to individual respiratory mechanics. This review examines the strengths and weaknesses of using transpulmonary pressure measurements to guide ventilator management in ARDS.
  
  
  RESULTS
  Recent clinical studies suggest that adjusting ventilator settings based on transpulmonary pressure measurements is feasible, may improve oxygenation, and reduce ventilator-induced lung injury.
  
  
  CONCLUSIONS
  The measurement of transpulmonary pressure relies upon esophageal manometry, which requires the acceptance of several assumptions and potential errors. Notably, this includes the ability of localized esophageal pressures to represent global pleural pressure. Recent investigations demonstrated improved oxygenation in ARDS patients when positive end-expiratory pressure was adjusted to target specific end-inspiratory or end-expiratory transpulmonary pressures. However, there are different methods for estimating transpulmonary pressure and different goals for positive end-expiratory pressure titration among recent studies. More research is needed to refine techniques for the estimation and utilization of transpulmonary pressure to guide ventilator settings in ARDS patients.
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Sarina K
authors.initials: SK
authors.lastname: Sahetya
authors.forename: Roy G
authors.initials: RG
authors.lastname: Brower
mesh_terms: D055371:Acute Lung Injury / Q000175:diagnosis* / Q000209:etiology; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008991:Monitoring, Physiologic / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States; D055397:Ventilator-Induced Lung Injury / Q000175:diagnosis*