Respiratory failure & ventilation
The pleural gradient does not reflect the superimposed pressure in patients with class III obesity
Authors' conclusion
In patients with class III obesity, the superimposed pressure does not approximate the pleural pressure gradient, which is higher than in patients with lower BMI. The quantity and distribution of subcutaneous and intrathoracic adiposity also contribute to increased pleural pressure gradients in individuals with BMI ≥ 40.
Study context
- Population
- ICU-admitted patients with acute respiratory failure who underwent chest CT within three days before/after esophageal manometry
- Participants
- 18 patients
- Exposure
- BMI ≥ 40 vs BMI < 30 kg/m²
- BMI ≥ 40n = 9
- BMI < 30n = 9reference
- Outcome
- Partitioned respiratory mechanics and superimposed pressure (pleural pressure gradient vs superimposed pressure)
Methodological detailssingle-centre
- Single-centre
Further findings
Esophageal pressure
P = 0.001
Pleural pressure gradient
P = 0.04
Superimposed pressure
P = 0.59
Thoracic adipose tissue and muscle (CT deep-learning segmentation)
- Subcutaneous and intrathoracic adipose tissue significantly higher with BMI ≥ 40; correlated positively with esophageal pressure and pleural pressure gradient
- P < 0.05
- Muscle areas did not differ between groups
Original publication
The pleural gradient does not reflect the superimposed pressure in patients with class III obesity. Crit Care. Published 16 September 2024. doi:10.
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