Respiratory Monitoring to Guide Treatment

…or “You don’t know what you don’t know”

A bit of a personal piece for me. And I think the title says it all. Unless you have all of the information, then it’s hard to have all of the answers. And this is very true for ventilation. We all know that ventilation can cause as much harm as it tries to cause good in some patients, but also in some parts of some patients. But who are those patients, and are we causing a little bit of harm in all of them (that could be avoided)?

Oesophageal Pressure Monitoring

Laurent Brochard makes a compelling case for measuring this.

9780007505142And after a short talk I get it. We make many assumptions about what’s going on at the pleural and alveolar level when we drive ventilation. But we don’t really know and now perhaps we can. And when you look at the respiratory mechanics you of course see that, like all science, and to use the words of Ben Goldacre, “I Think You’ll Find It’s a Bit More Complicated Than That”.

It seems that true ventilator-patient interaction might be more accessible when you measure oesophageal pressure, and potentially the opportunity for true tailored or individualised patient therapy, a recurring theme at this year’s ESICM.

Oesophageal pressure monitoring might be the ‘missing measurement’. And it’s not just for ARDS either. In his review, and in the interview I had the pleasure of having with him this morning, Brochard explains that during the spontaneous phase of breathing on the ventilator (weaning) there might be more information to had by measuring the oesophageal pressure.

Good information, good decisions

This all needs to be integrated into patient care, and added to the clinical picture, just as an ultrasonographer like me, who also uses a stethoscope, I won’t be hanging up the latter just yet, or making decisions about my patients just because of something I am shown on a screen.

The future of oesophageal pressure monitoring is interesting, and the ESICM’s PLUG Section are working towards refining this new old technology and hopefully giving us the thing that quickly prizes money from people’s hands, some outcome improvements.