A importância da pressão pleural na avaliação da mecânica respiratória

Cláudia Regina Fernandes

doi:10.1590/S0034-70942006000300009

Review Article

A importância da pressão pleural na avaliação da mecânica respiratória

Importance of pleural pressure for the evaluation of respiratory mechanics

Cláudia Regina Fernandes

http://dx.doi.org/10.1590/S0034-70942006000300009 Braz J Anesthesiol, vol.56, n3, p.287-303, 2006

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Resumo

JUSTIFICATIVA E OBJETIVOS: Para a partição das medidas de mecânica do sistema respiratório em seus componentes pulmão e parede torácica, faz-se necessário o conhecimento da pressão pleural. A finalidade desta revisão foi discutir sobre medidas alternativas à obtenção da pressão pleural para o cálculo da mecânica pulmonar, relatar as peculiaridades do método do balão esofágico para obtenção indireta da pressão pleural, as particularidades da obtenção da medida da pressão esofágica em pacientes sedados ou anestesiados, discorrer sobre a medida direta da pressão pleural e sua correlação com a pressão esofágica, assim como relatar sobre o reflexo da PEEP nas pressões pleural e esofágica. CONTEÚDO: A variação da pressão intra-esofágica reflete a variação da pressão intrapleural, podendo ser usada como medida alternativa à pressão pleural direta, no estudo da mecânica dos componentes pulmão e parede do sistema respiratório. A medida da pressão esofágica pode ser realizada por meio de um delicado balão posicionado no interior do esôfago. O método e a técnica foram observados e validados em seres humanos e animais em diferentes condições e posturas corporais. O emprego da PEEP em pacientes sob ventilação controlada mecânica está consolidado; no entanto, existem controvérsias da correlação próxima entre a pressão esofágica e a pressão pleural em pacientes ventilados com PEEP, o que pode resultar em erros de cálculo de mecânica respiratória considerando a pressão esofágica. CONCLUSÕES: O método do balão esofágico é o mais utilizado para a obtenção da medida indireta da pressão pleural. Em pacientes sedados ou anestesiados sem alterações significativas da complacência respiratória, a variação da pressão esofágica corresponde à variação da pressão pleural quando a PEEP é aplicada.

Palavras-chave

FISIOLOGIA, Pulmonar, FISIOLOGIA, Pulmonar, VENTILAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Pleural pressure has to be known for the partitioning of respiratory system mechanical measurements into their lung and chest wall components. This review aimed at discussing alternative methods to obtain pleural pressure to calculate pulmonary mechanics, at reporting peculiarities of the esophageal balloon method for obtaining indirect pleural pressure, peculiarities of esophageal pressure measurement in sedated or anesthetized patients, at discussing direct pleural pressure and its correlation with esophageal pressure, in addition to reporting on the impact of PEEP on pleural and esophageal pressures. CONTENTS: Esophageal pressure variation reflects pleural pressure variation and may be used as alternative to direct pleural pressure in the study of lungs and chest wall mechanics. Esophageal pressure may be obtained with a delicate balloon placed inside the esophagus. Method and technique were observed and validated in humans and animals in different conditions and body positions. PEEP is a consolidated method for patients under mechanically controlled ventilation, however there are controversies about the close correlation between esophageal and pleural pressure in patients ventilated with PEEP, which may result in wrong respiratory mechanics calculation based on the esophageal pressure. CONCLUSIONS: The esophageal balloon is the most common method to obtain indirect pleural pressure. In sedated or anesthetized patients without major respiratory compliance changes, esophageal pressure variation corresponds to pleural pressure variation when PEEP is applied.

Keywords

PHYSIOLOGY, Pulmonar, PHYSIOLOGY, Pulmonar, VENTILATION

Referencias

Luciani L. Delle oscillazioni della pressione intratoracica intrabdominale: Studio sperimentale. Arch Sci Med. 1878;2:177-224.

Buytendijk HJ. Oesophagusdruck em Longelasticiteit. .

Fry DL, Stead WW, Ebert RV. The measurement of intraesophageal pressure and its relationship to intrathoracic pressure. J Lab Clin Med. 1952;40:664-673.

Gillespie DJ, Lai Y, Hyatt RE. Comparison of esophageal and pleural pressures in the anesthetized dog. J Appl Physiol. 1973;35:709-713.

Baydur A, Behrakis PK, Zin WA. A simple method for assessing the validity of the esophageal balloon technique. Am Rev Respir Dis. 1982;126:788-791.

Lanteri CJ, Kano S, Sly PD. Validation of esophageal pressure occlusion test after paralysis. Pediatric Pulmonol. 1994;17:56-62.

Amato MB, Barbas CS, Medeiros DM. Beneficial effects of the "open lung approach" with low distending pressures in acute respiratory distress syndrome: A prospective randomized study on mechanical ventilation. Am J Respir Crit Care Med. 1995;152:1835-1846.

Auler Jr JOC, Bliacheriene F, Miyoshi E. Propostas em ventilação mecânica na síndrome da angústia respiratória. Rev Bras Anestesiol. 2001;51:558-564.

Higgs BD, Behrakis PK, Bevan DR. Measurement of pleural pressure with esophageal balloon in anesthetized humans. Anesthesiology. 1983;59:340-343.

D´Angelo E, Robatto FM, Calderini E. Pulmonary and chest wall mechanics in anesthetized paralyzed humans. J Appl Physiol. 1991;70:2602-2610.

Bonnet F, Fischler M, Dubois CL. Changes in intrathoracic pressures induced by positive end-expiratory pressure ventilation after cardiac surgical procedures. Ann Thorac Surg. 1986;42:406-411.

Otis AB, Rahn H, Fenn WO. Venous pressure changes associated with positive intra-pulmonary pressures; their relationship to the distensibility of the lung. Am J Physiol. 1946;146:307-317.

Dornhorst AC, Leathart GL. A method of assessing the mechanical properties of lungs and air-passages. Lancet. 1952;19:109-111.

Mead J, Mcilroy MB, Selverstone NJ. Measurement of intraesophageal pressure. J Appl Physiol. 1955;7:491-495.

Coates AL, Davis GM, Vallinis P. Liquid-filled esophageal catheter for measuring pleural pressure in preterm neonates. J Appl Physiol. 1989;67:889-893.

Papastamelos C, Panitch HB, Allen JL. Chest wall compliance in infants and children with neuromuscular disease. Am J Respir Crit Care Med. 1996;154:1045-1048.

Clarysse I, Demedts M. Human esophageal pressures and chest wall configuration in upright and head-down posture. J Appl Physiol. 1985;59:401-407.

Rajacich N, Burchard KW, Hasan F. Esophageal pressure monitoring: a practical adjuvant to hemodynamic monitoring with positive end-expiratory pressure. Heart Lung. 1988;17:483-488.

Karason S, Karlsen KL, Lundin S. A simplified method for separate measurements of lung and chest wall mechanics in ventilator-treated patients. Acta Anaesthesiol Scand. 1999;43:308-315.

Gappa M, Jackson E, Pilgrim L. A new microtransducer catheter for measuring esophageal pressure in infants. Pediatr Pulmonol. 1996;22:117-124.

Downs JB. A technique for direct measurement of intrapleural pressure. Crit Care Med. 1976;4:207-210.

Chapin JC, Downs JB, Douglas ME. Lung expansion, airway pressure transmission, and positive end-expiratory pressure. Arch Surg. 1979;114:1193-1197.

Pelosi P, Goldner M, Mckibben A. Recruitment and derecruitment during acute respiratory failure: an experimental study. Am J Respir Crit Care Med. 2001;164:122-130.

Tobin MJ, Jenouri A, Watson H. Noninvasive measurement of pleural pressure by surface inductive plethysmography. J Appl Physiol. 1983;55:267-275.

Wiener-Kronish JP, Gropper MA, Lai-Fook SJ. Pleural liquid pressure in dogs measured using a rib capsule. J Appl Physiol. 1985;59:597-602.

Olson LE, Lai-Fook SJ. Pleural liquid pressure measured with rib capsules in anesthetized ponies. J Appl Physiol. 1988;64:102-107.

Milic-Emili J, Mead J, Turner JM. Topography of esophageal pressure as a function of posture in man. J Appl Physiol. 1964;19:212-216.

Petit JM, Milic-Emili G. Measurement of endoesophageal pressure. J Appl Physiol. 1958;13:481-485.

Ferris BG, Mead J, Frank RN. Effect of body position on esophageal pressure and measurement of pulmonary compliance. J Appl Physiol. 1959;14:521-524.

Knowles JH, Hong SK, Rahn H. Possible errors using esophageal balloon in determination of pressure-volume characteristics of the lung and thoracic cage. J Appl Physiol. 1959;14:525-530.

Milic-Emili J, Mead J, Turner JM. Improved technique for estimating pleural pressure from esophageal balloons. J Appl Physiol. 1964;19:207-211.

Brown IG, Clean PA, Webster PM. Lung volume dependence of esophageal pressure in the neck. J Appl Physiol. 1985;59:1849-1854.

Zin WA, Caldeira MPR, Cardoso WV. Expiratory mechanics before and after uncomplicated heart surgery. Chest. 1989;95:21-28.

Gerhardt T, Bancalari E. Chestwall compliance in full-term and premature infants. Acta Paediatr Scand. 1980;69:359-364.

Fonseca-Costa A, Nardi AE. Relationship between mouth and esophageal pressures in different body postures. Braz J Med Biol Res. 1983;16:119-125.

Asher MI, Coates AL, Collinge JM. Measurement of pleural pressure in neonates. J Appl Physiol. 1982;52:491-494.

Correa FC, Ciminelli PB, Falcão H. Respiratory mechanics and lung histology in normal rats anesthetized with sevoflurane. J Appl Physiol. 2001;91:803-810.

Lanteri CJ, Kano S, Sly PD. Validation of esophageal pressure occlusion test after paralysis. Pediatr Pulmonol. 1994;17:56-62.

Barnas GM, Gilbert TB, Watson RJ. Respiratory mechanics in the open chest: effects of parietal pleurae. Respir Physiol. 1996;104:63-70.

Dechman G, Sato J, Bates JH. Factors affecting the accuracy of esophageal balloon measurement of pleural pressure in dogs. J Appl Physiol. 1992;72:383-388.

Baydur A, Sassoon C, Carlson M. Measurement of lung mechanics at different lung volumes and esophageal levels in normal subjects: effect of posture change. Lung. 1996;174:139-151.

Ingimarsson J, Thorsteinsson A, Larsson A. Lung and chest wall mechanics in anesthetized children: Influence of body position. Am J Respir Crit Care Med. 2000;162:412-417.

Zin WA, Milic-Emili J. Esophageal Pressure Measurement. Principles and Practice of Intensive Care Monitoring. 1998:545-552.

Beardsmore CS, Helms P, Stocks J. Improved esophageal balloon technique for use in infants. J Appl Physiol. 1980;49:735-742.

Klingstedt C, Baehrendtz S, Bindslev L. Lung and chest wall mechanics during differential ventilation with selective PEEP. Acta Anaesthesiol Scand. 1985;29:716-721.

Jardin F, Genevray B, Brun-Ney D. Influence of lung and chest wall compliances on transmission of airway pressure to the pleural space in critically ill patients. Chest. 1985;88:653-658.

Auler JO Jr, Zin WA, Caldeira MP. Pre- and postooperative inspiratory mechanics in ischemic and valvular heart disease. Chest. 1987;92:984-990.

Ruiz Neto PP, Auler Júnior JO. Respiratory mechanical properties during fentanyl and alfentanil anaesthesia. Can J Anaesth. 1992;39:458-465.

Baydur A, Sassoon CS, Stiles CM. Partitioning of respiratory mechanics in young adults Effects of duration of anesthesia. Am Rev Respir Dis. 1987;135:165-172.

Nava S, Rubini F. Lung and chest wall mechanics in ventilated patients with end stage idiopathic pulmonary fibrosis. Thorax. 2000;54:390-395.

D'Angelo E, Calderini E, Torri G. Respiratory mechanics in anesthetized paralyzed humans: effects of flow, volume, and time. J Appl Physiol. 1989;67:2556-2564.

Putensen C, Leon MA, Putensen-Himmer G. Effect of neuromuscular blockade on the elastic properties of the lungs, thorax, and total respiratory system in anesthetized pigs. Crit Care Med. 1994;22:1976-1980.

Pelosi P, Croci M, Ravagnan I. Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest. 1996;109:144-151.

Zin WA, Pengelly LD, Milic-Emili J. Single-breath method for measurement of respiratory mechanics in anesthetized animals. J Appl Physiol. 1982;52:1266-1271.

Behrakis PK, Higgs BD, Baydur A. Respiratory mechanics during halothane anesthesia and anesthesia-paralysis in humans. J Appl Physiol. 1983;55:1085-1092.

Zin WA, Boddener A, Silva PR. Active and passive respiratory mechanics in anesthetized dogs. J Appl Physiol. 1986;61:1647-1655.

Gottfried SB, Higgs BD, Rossi A. Interrupter technique for measurement of respiratory mechanics in anesthetized humans. J Appl Physiol. 1985;59:647-652.

Bates JH, Rossi A, Milic-Emili J. Analysis of the behavior of the respiratory system with constant inspiratory flow. J Appl Physiol. 1985;58:1840-1848.

Bates JH, Baconnier P, Milic-Emili J. A theoretical analysis of interrupter technique for measuring respiratory mechanics. J Appl Physiol. 1988;64:2204-2214.

Don HF, Robson JG. The mechanics of the respiratory system during anesthesia: The effects of atropine and carbon dioxide. Anesthesiology. 1965;26:168-178.

Rattenborg CC, Holaday D. Constant flow inflation of the lungs: Theoretical analysis. Acta Anaesth Scandin. 1966;23:211-223.

Fukaya H, Martin CJ, Young AC. Mechanical properties of alveolar walls. J Appl Physiol. 1968;25:689-695.

Jonson B, Beydon L, Brauer K. Mechanics of respiratory system in healthy anesthetized humans with emphasis on viscoelastic properties. J Appl Physiol. 1993;75:132-140.

Auler Jr JO, Miyoshi E, Fernandes CR. The effects of abdominal opening on respiratory mechanics during general anesthesia in normal and morbidly obese patients: a comparative study. Anesth Analg. 2002;94:741-748.

Fernandes CR, Auler Jr JO. Study between esophageal and pleural pressure in anesthetized humans at different levels of PEEP ASA Annual Meeting. Respiration. 2001;95:A1345.

Cherniack RM, Farhi LE, Armstrong BW. A compararison of esophageal and intrapleural pressure in man. J Appl Physiol. 1955;8:203-211.

Attinger EO, Monroe RG, Segal MS. The mechanics of breathing in different body positions. I: In normal Subjects. J Clin Invest. 1956;35:904-911.

Mead J, Gaensler EA. Esophageal and pleural pressures in man, upright and supine. J Appl Physiol. 1959;14:81-83.

Daly WJ, Bondurant S. Direct measurement of respiratory pleural pressure changes in normal man. J Appl Physiol. 1963;18:513-518.

Craven KD, Wood LD. Extrapericardial and esophageal pressures with positive end-expiratory pressure in dogs. J Appl Physiol. 1981;51:798-805.

Marini JJ, O'Quin R, Culver BH. Estimation of transmural cardiac pressures during ventilation with PEEP. J Appl Physiol. 1982;53:384-391.

O'Quin RJ, Marini JJ, Culver BH. Transmission of airway pressure to pleural space during lung edema and chest wall restriction. J Appl Physiol. 1985;59:1171-1177.

Smiseth OA, Veddeng O. A comparison of changes in esophageal pressure and regional juxtacardiac pressures. J Appl Physiol. 1990;69:1053-1057.

Smiseth AO, Thompson CR, Ling H. Juxtacardiac pleural pressure during positive end-expiratory pressure ventilation: an intraoperative study in patients with open pericardium. J Am Coll Cardiol. 1994;23:753-758.

Auler Jr JO, Fernandes CR. Acquisition of esophageal pressure in anaesthetized patients. Nederlandse Vereniging voor Intensive Care. 2003;7:213-216.

A importância da pressão pleural na avaliação da mecânica respiratória

Importance of pleural pressure for the evaluation of respiratory mechanics

Cláudia Regina Fernandes

Resumo

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Abstract

Keywords

Referencias

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