Respiratory failure & ventilation
Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients
Authors' conclusion
In mechanically ventilated patients with acute respiratory failure, the digital filtered CVP estimated ΔPES and PL obtained from digital filtered CVP represented a reliable value of standard PL measured with the esophageal method and could identify patients with non-protective ventilation settings.
Study context
- Population
- Patients with acute respiratory failure (PaO2/FiO2 below 200 mmHg) on invasive mechanical ventilation, monitored with esophageal balloon and central venous catheter
- Participants
- 20 patients
- Comparison
- Transpulmonary pressure from central venous pressure (CVP) and digitally filtered CVP (f-CVP) vs esophageal pressure (PES)
- Outcome
- Accuracy of ΔCVP and Δf-CVP in estimating ΔPES, agreement of PL from CVP, f-CVP and PES, and diagnostic accuracy of f-CVP for PL>10 cmH2O
Performance
As reported in the abstract
Agreement with esophageal method
- Δf-CVP vs ΔPES
- correlation r 0.8; P = 0.001
- ΔCVP vs ΔPES
- correlation r 0.08; P = 0.73
- Δf-CVP vs ΔPES
- Bland Altman mean bias - 0.16 cmH2O (Limits of Agreement (LoA) CI −1.31 to 0.98)
- ΔCVP vs ΔPES
- Bland Altman mean bias - 0.79 cmH2O (LoA CI - 3.14, 1.55)
- PLf-CVP vs PLPES
- correlation r 0.98; P < 0.001
- PLCVP vs PLPES
- correlation r 0.94; P < 0.001
- PLf-CVP vs PLPES
- Bland Altman bias 0.15 cmH2O (LoA CI - 0.95, 1.26)
- PLCVP vs PLPES
- Bland Altman bias 0.80 cmH2O (LoA CI - 1.51, 3.12)
Further findings
| Outcome | PLf-CVP | AUC difference (CI) | P value |
|---|---|---|---|
| Discrimination of high PL (PL>10 cmH2O)PLf-CVP vs PLPES | 0.01 (−0.024 to 0.05) | P = 0.48 | |
| AUC | 0.99 (SD 0.02) |
Original publication
Estimation of the transpulmonary pressure from the central venous pressure in mechanically ventilated patients. J Clin Monit Comput. Published 21 March 2024. doi:10.
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