Intubated patients with the acute respiratory distress syndrome (ARDS) are usually treated with protective ventilation limiting plateau pressure below 30 centimeter of water (cmH2O) and, if possible, a driving pressure under 15 cmH2O. However, these airway pressures might not reflect the actual pressure applied to the lung. Transpulmonary pressure is the difference between airway pressure and pleural pressure, the latter is estimated by the esophageal pressure, and so it better reflects the ventilatory induced lung injury (VILI).
One of the consequences of the VILI is a increase of pulmonary edema and it could be estimated by the extravascular lung water, obtained by trans-pulmonary thermodilution.
So it could exist a link between the driving trans-pulmonary pressure and the extravascular lung water.
Acute respiratory distress syndrome (ARDS)
Monitoring with a transpulmonary thermodilution device
Esophageal pressure monitoring
Legal protection measures
Pregnancy
Contra-indications of esophageal catheter : esophageal varicose, severe coagulopathy
Patients intubated in the medical ICU of Bicêtre hospital (Academic hospital), Le Kremlin Bicêtre, France
Cohort
Prospective
Not listed
Association between the transpulmonary driving pressure and the extravascular lung water (EVLW)
On the first day of patient's respiratory and hemodynamics monitoring, we will collect transpulmonary driving pressure and extra-vascular lung water values. We will calculate the correlation coefficient linking these two variables to assess if their association.
Association between the transpulmonary driving pressure and the pulmonary vascular permeability index (PVPI)
On the first day of patient's respiratory and hemodynamics monitoring, we will collect transpulmonary driving pressure and PVPI values. We will calculate the correlation coefficient linking these two variables to assess if their association.
Correlation between the transpulmonary driving pressure at admission and the ICU-mortality
Multivariable analysis of factors associated with ICU mortality, including initial severity, comorbidities, respiratory mechanics covariates, EVLW and pulmonary vascular permeability index (PVPI).
Correlation between the extravascular lung water at admission and the ICU-mortality
Multivariable analysis of factors associated with ICU mortality, including initial severity, comorbidities, respiratory mechanics covariates, EVLW and pulmonary vascular permeability index (PVPI).
Influence of position on plateau pressure
Plateau pressure will be measured at 0°, 30° and 45° position and we will compare the values to assess if the position impacts this pressure.
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