Mechanical ventilation is a critical intervention in the management of pediatric patients with respiratory distress. During this process, accurate measurement of transpulmonary pressure (PL) is essential to ensure the safety and efficacy of ventilation. PL is defined as the difference between alveolar pressure (Palv) and pleural pressure (Ppl). While the direct measurement of Ppl is possible, it poses a risk to tissue integrity. Thus, the primary surrogate for Ppl measurement today is esophageal pressure (Pes).
However, the measurement of Pes is not without challenges. This abstract outlines the pitfalls associated with Pes measurement, emphasizing the importance of employing well-defined procedures to mitigate potential errors. These errors can range from underestimation of Pes due to underfilled catheters to overestimation resulting from overfilled catheters.
To address these challenges and optimize Pes measurement, various methods have been proposed for titrating the filling volume of the esophageal catheter. In this study, investigators aim to assess a faster decremental filling method and compare it to the traditionally accepted Mojoli method in the context of pediatric patients. This research seeks to enhance the intensivists' understanding of the most efficient and accurate approach to Pes measurement during mechanical ventilation in the pediatric population, ultimately contributing to improved patient care and outcomes
Pediatric patients between 1 months and 18 years
Patients need mechanical ventilation support without modification of ventilation settings within the upcoming 2 hours
Informed consent was signed by next of kin
Requiring esophageal catheter application
Patients eligible for extubation or modification of ventilation settings within the upcoming 2 hours
Patient included in another interventional study in the last 30 days
Patients unable to undergo esophageal catheter insertion due to congenital or acquired pathologies
Patient included in another interventional research study under consent
Crossover
Fast method
Other interventionFast decremental catheter volume titration will be applied and optimal filling volume will be determined according to the measurements
Conventional method
Other interventionConventional catheter volume titration will be applied and optimal filling volume will be determined according to the measurements
Optimal catheter filling volume
The clinician will determine the optimal filling volume of the catheter using two distinct methods
Transpulmonary driving pressure
The measured transpulmonary driving pressure achieved using the optimal filling volume of the catheter
Time
The duration necessary to ascertain the optimal filling volume of the esophageal catheter
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