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Sitting and Supine Esophageal Pressures in Overweight and Obese Subjects
Author(s) -
Owens Robert L.,
Campana Lisa M.,
Hess Lauren,
Eckert Danny J.,
Loring Stephen H.,
Malhotra Atul
Publication year - 2012
Publication title -
obesity
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.438
H-Index - 199
eISSN - 1930-739X
pISSN - 1930-7381
DOI - 10.1038/oby.2012.120
Subject(s) - supine position , medicine , overweight , sitting , anthropometry , waist , spirometry , body mass index , physical therapy , anesthesia , asthma , pathology
Esophageal pressure (P Es ) can be used to approximate pleural pressure (P pl ) and might be clinically useful, particularly in the obese e.g., to guide mechanical ventilator settings in critical illness. However, mediastinal artifact (the difference between true P pl and P Es ) may limit acceptance of the measurement, and reproducibility of P Es measurements remains unknown. Therefore, we aimed to assess the effect of body posture on P Es in a cohort of obese, but healthy subjects, some of whom had multiple measurements, to address the clinical robustness of esophageal manometry. Twenty‐five overweight and obese subjects (BMI > 25 kg/m 2 ) and 11 control lean subjects (BMI < 25 kg/m 2 ) underwent esophageal manometry with pressures measured seated and supine. Twenty overweight and obese subjects had measurements repeated after ∼1 to 2 weeks. Anthropometric data and sitting and supine spirometry were recorded. The average end‐expiratory P Es sitting and supine were greater in the overweight and obese group than the lean group (sitting −0.1 ± 2.1 vs. −3.3 ± 1.2 cmH 2 O, supine 9.3 ± 3.3 vs. 6.9 ± 2.8 cmH 2 O, respectively). The mean differences between repeated measurements were small (−0.3 ± 1.7 cmH 2 O sitting and −0.1 ± 1.5 cmH 2 O supine). P Es correlated with a number of anthropometric and spirometric variables. In conclusion, P Es are slightly greater in overweight and obese subjects than lean subjects; but changes with position are similar in both groups. These data indicate that mediastinal weight and postural effects on P Es are within a clinically acceptable range, and suggest that esophageal manometry can be used to inform clinical decision making across wide range of body types.