SCCM Resource Library-Perspectives: Esophageal Pressure for PEEP Titration

Video Transcription

Video Summary

Dr. Jeremy Butler presented a talk on esophageal pressure-guided positive end-expiratory pressure (PEP) titration for patients with acute respiratory distress syndrome (ARDS). He discussed the role of transpulmonary pressure in determining lung stress and the use of esophageal balloon catheters to measure pleural pressure. The EPVENT1 trial compared esophageal pressure-guided PEEP titration with the ARDSNet low PEEP strategy and found a significant mortality benefit in patients with mild ARDS. However, follow-up analysis with the EPVENT2 trial did not confirm these findings. Dr. Butler then analyzed the EPVENT2 data further and found that the treatment effect of esophageal pressure-guided PEEP titration depended on the baseline risk of death. Patients with lower APACHE scores had a mortality benefit, while those with higher scores did not. He proposed that an ideal PEEP strategy would aim for a transpulmonary pressure near zero at end expiration and simultaneously lower tidal volume to minimize overdistension. Ultimately, Dr. Butler acknowledged that further research is needed to fully understand the benefits and implementation of esophageal pressure-guided PEEP titration.

Asset Subtitle

Pulmonary, Procedures, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Define the setup for measuring esophageal pressure on different ventilators
Recognize the physiology of esophageal pressure monitoring on gas exchange and lung injury
Determine which patients will benefit from esophageal pressure monitoring and which will not

Pros and Cons of Esophageal Pressure in PEEP Titration
Jeremy R. Beitler

Meta Tag

Content Type Presentation

Knowledge Area Pulmonary

Knowledge Area Procedures

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Positive End Expiratory Pressure PEEP

Tag Mechanical Ventilation

Year 2021

Keywords

esophageal pressure-guided PEEP titration

ARDS

transpulmonary pressure

EPVENT2 trial

mortality benefit

baseline risk of death

APACHE scores

ideal PEEP strategy

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