Étude comparative des pressions pleurale et œsophagienne au cours de la ventilation mécanique chez les patients transplantés bi-pulmonaires

Abstract : Introduction: Esophageal manometry is an interesting tool to assess the value of pleural pressure in patients under mechanical ventilation.Experimental data suggests that oesophageal pressure may overestimate pleural pressure in non-dependent lung regions. The objective of this study was to compare, during the postoperative period of bilatéral lung transplantation, the esophageal pressure (Pes) at the pleural pressure measured in the dependent (PPL, D) and non-dependent (P PL, ND) regions of the lung Methods: We have included bilatéral lung transplant recipient, in whom, at the end of the procedure, pleural catheters were inserted by the surgeons, in the dependent and non-dependent regions of the lung, along the surgical thoracic tube. After admission to intensive care, Pes was measured and compared to dependent and non-dependent pleural pressures under passive conditions, patients were deeply sedated. Results: Sixteen transplant patients were included. Fourteen of them had valid data and were analyzed. Dependent (PPL, D) and non-dependent (PPL, ND) pleural pressures were correlated with both inspiratory and expiratory time to Pes respectively, R2 = 0.64 and 0.65 p = 0.01. Pes was systematically measured higher than PPL ND and most of the time at PPL D. The transpulmonary pressure (PL) calculated with Pes was close to those directly measured in the dependent regions but underestimated those measured in the non-dependent regions. Transpulmonary pressure calculated with Pes by elastance ratio method (PL, ER) approximated the non-dependent pleural pressure. The average gradient between PPL ND and PPL D was 6 cm H2O Conclusions: Pes over estimate pleural pressure in non-dependent regions of the lung leading to underestimate the regional transpulmonary pressure. The transpulmonary pressure calculated by the elastance ratio method corrects this problem.
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Submitted on : Tuesday, July 2, 2019 - 12:06:00 PM
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Antoine Tilmont. Étude comparative des pressions pleurale et œsophagienne au cours de la ventilation mécanique chez les patients transplantés bi-pulmonaires. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02170674⟩

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