Position and Esophageal Pressure

Impact of Patient Position on the Value of Esophageal Pressure. pEsition Study.

Esophageal pressure measurements are used in moderate/severe Accurate Respiratory Distress SyndromeARDS patients in order to set ventilator settings. There might be variations of the measured value according to the patient position (0° vs 30°) at the time of measurements.

Inclusion Criteria:

• Age ≥ 18 years

• Acute respiratory failure defined by PaO2/FIO2< 300 mmHg or pH<7,35 and pCO2>45mmHg or Moderate or severe Accurate Respiratory Distress Syndrome ARDS defined by:

  • New or worsening respiratory symptoms in the previous week.
  • Bilateral opacities-not fully explained by effusions, lobar/lung collapse, or Nodules
  • Respiratory failure not fully explained by cardiac failure or fluid overload
  • PaO2/FIO2< 200 mmHg and PEEP ≥ 5 cm H2O and VT ≤6 ml/kg of Ideal Body Weight

• Patient intubated or tracheotomized and receiving mechanical ventilation

• Indication of esophageal measurement decided by the clinician

Exclusion Criteria:

• Contraindication to naso-gastric tube insertion :

  • Recent gastro-duodenal ulcer
  • Stage III esophageal varices

• Refractory intracranial hypertension

• Unstabilized spine fracture

• Surgical contraindication

• Burns on more than 20 % of the body surface

• Underlying disease with a life expectancy of less than one year

• End-of-life decision before inclusion

• Pregnant or breast-feeding patients

• Subject deprived of freedom, minor, subject under a legal protective measure

• Research team unavailability

• Lack of medical care plan