Evaluation of Optimal Esophageal Catheter Balloon Inflation Volume in Mechanically Ventilated Children

BACKGROUND: Accuracy of esophageal pressure measured by an air-filled esophageal balloon catheter is dependent on balloon filling volume. However, this has been understudied in mechanically ventilated children. We sought to study the optimal filling volume in children receiving ventilation by using previously reported calibration methods. Secondary objectives included to examine the difference in pressure measurements at individualized optimal filling volume versus a standardized inflation volume and to study if a static hold during calibration is required to identify the optimal filling volume.

METHODS: An incremental inflation calibration procedure was performed in children receiving ventilation, <18 y, instrumented with commercially available catheters (6 or 8 French) who were not breathing spontaneously. The balloon was manually inflated by 0.2 to 1.6 mL (6 French) or 2.6 mL (8 French). Esophageal pressure (P es) and airway pressure tracings were recorded during the procedure. Data were analyzed offline by using 2 methods: visual determination of filling range with the calculation of the highest difference between expiratory and inspiratory P es and determination of a correctly filled balloon by calculating the esophageal elastance.

RESULTS: We enrolled 40 subjects with median (interquartile range [IQR]) age 6.8 (2-25) months. The optimal filling volume ranged from 0.2 to 1.2 mL (median [IQR] 0.6 [0.2-1.0] mL) in the subjects with a 6 French catheter and 0.2-2.0 mL (median [IQR] 0.7 [0.5-1.2] mL) for 8 French catheters. Inflating the balloon with 0.6 mL (median computed from the whole cohort) gave an absolute difference in transpulmonary pressure that ranged from -4 to 7 cm H 2O compared with the personalized volume. P es calculated over 5 consecutives breaths differed with a maximum of 1 cm H 2O compared to P es calculated during a single inspiratory hold. The esophageal elastance was correlated with weight, age, and sex.

CONCLUSIONS: The optimal balloon inflation volume was highly variable, which indicated the need for an individual calibration procedure. P es was not overestimated when an inspiratory hold was not applied.