title: Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives.
abstract: OBJECTIVE
  Esophageal pressure (Pes) is a minimally invasive advanced respiratory monitoring method with the potential to guide management of ventilation support and enhance specific diagnoses in acute respiratory failure patients. To date, the use of Pes in the clinical setting is limited, and it is often seen as a research tool only.
  
  
  METHODS
  This is a review of the relevant technical, physiological and clinical details that support the clinical utility of Pes.
  
  
  RESULTS
  After appropriately positioning of the esophageal balloon, Pes monitoring allows titration of controlled and assisted mechanical ventilation to achieve personalized protective settings and the desired level of patient effort from the acute phase through to weaning. Moreover, Pes monitoring permits accurate measurement of transmural vascular pressure and intrinsic positive end-expiratory pressure and facilitates detection of patient-ventilator asynchrony, thereby supporting specific diagnoses and interventions. Finally, some Pes-derived measures may also be obtained by monitoring electrical activity of the diaphragm.
  
  
  CONCLUSIONS
  Pes monitoring provides unique bedside measures for a better understanding of the pathophysiology of acute respiratory failure patients. Including Pes monitoring in the intensivist's clinical armamentarium may enhance treatment to improve clinical outcomes.
authors.affiliation: Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Mauri
authors.affiliation: Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.|Intensive Care Unit, Osaka University Hospital, Suita, Japan.|Department of Anesthesia, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Health Science, University of Milan-Bicocca, Monza, MB, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bellani
authors.affiliation: Department of Physiology, University of Toronto, Toronto, Canada.|Division of Respirology, Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.|Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Ewan C
authors.initials: EC
authors.lastname: Goligher
authors.affiliation: DHU A-TVB, Service de Réanimation Médicale, CHU Henri Mondor, Assistance Publique-Hôpitaux de Paris, , Créteil, France.|Groupe de recherche clinique CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, Créteil, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Carteaux
authors.affiliation: Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand.|Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.|Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Nuttapol
authors.initials: N
authors.lastname: Rittayamai
authors.affiliation: Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mojoli
authors.affiliation: Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.|Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Chiumello
authors.affiliation: Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland.|Department of Medical Intensive Care, University Hospital of Angers, Angers, France.
authors.forename: Lise
authors.initials: L
authors.lastname: Piquilloud
authors.affiliation: Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari "Aldo Moro", Bari, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Grasso
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Edward Hines Jr., Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL, USA.
authors.forename: Amal
authors.initials: A
authors.lastname: Jubran
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Edward Hines Jr., Veterans Affairs Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, IL, USA.
authors.forename: Franco
authors.initials: F
authors.lastname: Laghi
authors.affiliation: Department of Critical Care, McGill University Heath Centre, Glen Site Campus, Montreal, QC, Canada.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Magder
authors.affiliation: Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.|Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Loring
authors.affiliation: Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.|Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Talmor
authors.affiliation: Institut de Investigació i Innovació Parc Taulí, CIBER Enfermedades Respiratorias, Critical Care Center, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Blanch
authors.affiliation: Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Amato
authors.affiliation: Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.|Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Lu
authors.initials: L
authors.lastname: Chen
authors.affiliation: Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. BrochardL@smh.ca.|Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. BrochardL@smh.ca.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.affiliation: Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Mancebo
mesh_terms: D002404:Catheterization / Q000379:methods*; D003964:Diaphragm / Q000503:physiopathology; D004947:Esophagus / Q000502:physiology; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy; D015656:Respiratory Mechanics / Q000502:physiology*; D015300:Ventilator Weaning / Q000379:methods
keywords: Acute respiratory distress syndrome; Acute respiratory failure; Esophageal pressure; Mechanical ventilation; Physiologic monitoring