Objective To explore whether positive end-expiratiory pressure (PEEP) guided by the esophageal balloon manometry is better than the ARDS Network standard of care recommendations during treating traumatic acute respiratory distress syndrome (ARDS) patients with mechanical ventilation. Methods Twelve traumatic ARDS patients selected from September 2013 to March 2015 in ICU of Xiamen No. 3 Hospital were administrated esophageal balloor catheter and underwent mechanical ventilation with PEEP adjusted according to measurements of esophageal pressure and the ARDS Network standard of care recommendations simultaneously. According to the selection method of PEEP, the patients were divided into two groups:the esophageal pressure guided group and the ARDS Network recommendations guided group (the control group). The changes of peak inspiratory pressure, esophageal pressure, transpulmonary end-expiratory pressure, transpulmonary end-inpiratory pressure, lung compliance at 0 h, 24 h, 48 h, 72 h following different PEEP treatments were observed and compared between two groups of patients. Results A mean PEEP in the esophageal pressure guided group of (10.98±4.36)cm H₂O was significantly higher than the control group of (7.13±2.21)cm H₂O (P<0.01). The transpulmonary end-expiratory pressure was significantly higher in the esophageal pressure guided group (0.71±0.62)cm H₂O than the control group (-2.29±3.49) cm H₂O. And all of the mean transpulmonary end-expiratory pressure remained above zero in the esophageal pressure guided group, whereas in the control group 73% patients remained negative (P<0.01). Conclusions Esophageal pressure method adjusts PEEP for traumatic ARDS patients with mechanical ventilation through estimating pleural pressure so as to calculate transpulmonary pressure. It can identify traumatic ARDS patients who would benefit from the high PEEP, adjust PEEP individually and meet patients' need more satisfactorily.

Citation： RanYanni, WuBin, WangBing. Comparison of Esophageal Pressure Measurement with ARDS Network Standard of Care Recommendations in Selection of Positive End-expiratiory Pressure for Traumatic ARDS Patients with Mechanical Ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(6): 565-568. doi: 10.7507/1671-6205.2015137 Copy