A simplified method for separate measurements of lung and chest wall mechanics in ventilator-treated patients

Background: Airway pressure measurements above the endotracheal tube will be distorted because of endotracheal tube resistance. To separate lung and chest wall compliance, esophageal pressure is conventionally measured with an air-filled balloon catheter, which is difficult to insert in unconscious patients. We have developed a methodology with fluid-filled catheters for intratracheal and esophageal pressure measurements. Methods: Twelve anesthetized patients were studied. Tidal volumes were measured by side-stream spirometry. Airway pressures were measured at the Y-piece and in the trachea with fluid-filled pressure lines. Esophageal pressure was measured via the narrow lumen in a fluid-filled SalemTM double-lumen stomach tube, which was slowly retracted from the stomach up through the esophagus until maximal respiratory pressure readings and minimal cardiac artifacts were obtained. Lung mechanics were measured at different tidal volumes (TV) and positive end-expiratory pressure (PEEP). Results: There was a significant difference between airway pressures at the Y-piece and in the trachea. Total compliance significantly increased with increasing TV and decreased with increasing PEEP. Chest wall compliance increased significantly with increasing TV, while lung compliance did not change significantly. Two patients showed repeatedly marked increase in lung compliance at one specific ventilatory setting, an increase the proportion of which was not reflected by changes in total compliance. Conclusions: Y-piece pressures are not representative of intratracheal pressures, which can be measured by inserting a fluid-filled pressure line through the tube. Esophageal pressure is easily recorded with a fluid-filled SalemTM double-lumen catheter. Large changes in lung compliance may pass unnoticed when only total compliance is monitored. Monitoring of lung compliance may offer an improved basis for decisions about ventilator settings.