Impact of catheter positioning on Pes measurements in mechanically ventilated ICU patients

Introduction: Accurate interpretation of esophageal pressure (Pes) requires correct catheter positioning, as pressure varies along the esophagus. The measurement location with a balloon catheter is uncertain, depending on catheter design. A solid-state sensor measures Pes at a fixed point, allowing more standardized measurement and to study how position influences values. Objectives: To assess pressure variation along the esophagus. We hypothesized that sensor position affects Pes measurements. Methods: Further analysis of previous work [1] in 16 passively mechanically ventilated patients. After a baseline measurement at mid-esophageal position (see [1]), the solid-state catheter was withdrawn by 10 cm while maintaining ventilator settings. Static Pes values were obtained (holds). Results: Catheter repositioning changed end-inspiratory, end-expiratory, and delta Pes values (median [IQR] difference from baseline position): –1.3 [4.5], –0.8 [5.6], and 0.0 [3.5] cmH₂O, respectively, example in figure 1AB. There was no consistent trend in these Pes changes (Figure 1CD). Conclusion: Absolute and delta Pes values vary within the esophageal tract, which impacts respiratory mechanics monitoring. Standardized positioning of esophageal catheters is key for optimal interpretation. Solid-state sensor catheters may improve standardized positioning because of their location-specific sensor. 1. van Oosten JP, et al. PMID: 39871347