Different ventilation strategies have been suggested in the past in patients with
acute respiratory distress syndrome (ARDS). Airway pressure monitoring alone is inadequate to assure optimal ventilatory support in ARDS patients. The assessment of transpulmonary pressure (PTP) can help clinicians to tailor
mechanical ventilation to the individual patient needs. Transpulmonary pressure monitoring, defined as airway pressure (Paw) minus intrathoracic pressure (
ITP), provides essential information about chest wall mechanics and its effects on the respiratory system and lung mechanics. The positioning of an esophageal
catheter is required to measure the esophageal pressure (Peso), which is clinically used as a surrogate for
ITP or pleural pressure (Ppl), and calculates the transpulmonary pressure. The benefits of such a ventilation approach are avoiding excessive lung stress and individualizing the
positive end-expiratory pressure (PEEP) setting. The aim is to prevent over-distention of alveoli and the cyclic recruitment/derecruitment or shear stress of lung parenchyma, mechanisms associated with
ventilator-induced lung injury (VILI). Knowledge of the real lung distending pressure, i.e. the transpulmonary pressure, has shown to be useful in both controlled and assisted
mechanical ventilation. In the latter
ventilator modes, Peso measurement allows one to assess a patient's respiratory effort,
patient-ventilator asynchrony,
intrinsic PEEP and the calculation of work of breathing. Conditions that have an impact on Peso, such as abdominal
hypertension, will also be discussed briefly.