Practical Aspects of Esophageal Pressure Monitoring in Patients with Acute Respiratory Distress Syndrome

Esophageal pressure (P(es)) monitoring is a minimally invasive advanced respiratory monitoring method with the potential to guide ventilation support management. P(es) monitoring enables the separation of lung and chest wall mechanics and estimation of transpulmonary pressure, which is recognized as an important risk factor for lung injury during both spontaneous breathing and mechanical ventilation. Appropriate balloon positioning, calibration, and measurement techniques are important to avoid inaccurate results. Both the approach of using absolute expiratory Pes values and the approach based on tidal Pes difference have shown promising results for ventilation adjustments, with the potential to decrease the risk of ventilator-induced lung injury.