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Objectives: This study aims to determine whether Trans pulmonary Pressure can be measured in children using Esophageal Pressure as a surrogate of Pleural Pressure (PPL). To reach this goal, we wanted to validate the reliability of two Esophageal Pressure recording methods compared to direct PPL measurement in situ. Study design This is a prospective study. Methodology: Mechanically ventilated children were included if they had at least one chest tube. PPL was directly measured into the existing chest tube (PCH-TUBE). Esophageal Pressure was measured by two methods: a catheter mounted pressure transducer system (PES-REF) and the preexisting nasogastric feeding tube pulled out in order to be located in the mid third of the esophagus (PES-FT). Results: Twelve patients were enrolled, and eight patients (median age: 4 months) were included in the analysis. For each method, the 2 measurements obtained with the same method were concordant. In the Bland-Altman analysis, the limits of agreement were wide for all between-method comparisons, from +/8 to +/15 cmH2O. Conclusion: Prior to consider its use in clinical practice, in particular for the titration of the ventilator support, it is essential to conduct more research in order to validate the measurement technique of Esophageal Pressure and confirm that it can accurately reflect the PPL.

Does esophageal pressure monitoring reliably permit to estimate transpulmonary pressure in children?