TY - JOUR
T1 - Sitting and Supine Esophageal Pressures in Overweight and Obese Subjects
AU - Owens, Robert L.
AU - Campana, Lisa M.
AU - Hess, Lauren
AU - Eckert, Danny J.
AU - Loring, Stephen H.
AU - Malhotra, Atul
PY - 2012/12/31
Y1 - 2012/12/31
N2 - Esophageal pressure (P Es) can be used to approximate pleural pressure (P pl) and might be clinically useful, particularly in the obese e.g., to guide mechanical ventilator settings in critical illness. However, mediastinal artifact (the difference between true P pl and P Es) may limit acceptance of the measurement, and reproducibility of P Es measurements remains unknown. Therefore, we aimed to assess the effect of body posture on P Es in a cohort of obese, but healthy subjects, some of whom had multiple measurements, to address the clinical robustness of esophageal manometry. Twenty-five overweight and obese subjects (BMI > 25 kg/m 2) and 11 control lean subjects (BMI 25 kg/m 2) underwent esophageal manometry with pressures measured seated and supine. Twenty overweight and obese subjects had measurements repeated after ∼1 to 2 weeks. Anthropometric data and sitting and supine spirometry were recorded. The average end-expiratory P Es sitting and supine were greater in the overweight and obese group than the lean group (sitting 0.1 ± 2.1 vs. 3.3 ± 1.2 cmH 2 O, supine 9.3 ± 3.3 vs. 6.9 ± 2.8 cmH 2 O, respectively). The mean differences between repeated measurements were small (0.3 ± 1.7 cmH 2 O sitting and 0.1 ± 1.5 cmH 2 O supine). P Es correlated with a number of anthropometric and spirometric variables. In conclusion, P Es are slightly greater in overweight and obese subjects than lean subjects; but changes with position are similar in both groups. These data indicate that mediastinal weight and postural effects on P Es are within a clinically acceptable range, and suggest that esophageal manometry can be used to inform clinical decision making across wide range of body types.
AB - Esophageal pressure (P Es) can be used to approximate pleural pressure (P pl) and might be clinically useful, particularly in the obese e.g., to guide mechanical ventilator settings in critical illness. However, mediastinal artifact (the difference between true P pl and P Es) may limit acceptance of the measurement, and reproducibility of P Es measurements remains unknown. Therefore, we aimed to assess the effect of body posture on P Es in a cohort of obese, but healthy subjects, some of whom had multiple measurements, to address the clinical robustness of esophageal manometry. Twenty-five overweight and obese subjects (BMI > 25 kg/m 2) and 11 control lean subjects (BMI 25 kg/m 2) underwent esophageal manometry with pressures measured seated and supine. Twenty overweight and obese subjects had measurements repeated after ∼1 to 2 weeks. Anthropometric data and sitting and supine spirometry were recorded. The average end-expiratory P Es sitting and supine were greater in the overweight and obese group than the lean group (sitting 0.1 ± 2.1 vs. 3.3 ± 1.2 cmH 2 O, supine 9.3 ± 3.3 vs. 6.9 ± 2.8 cmH 2 O, respectively). The mean differences between repeated measurements were small (0.3 ± 1.7 cmH 2 O sitting and 0.1 ± 1.5 cmH 2 O supine). P Es correlated with a number of anthropometric and spirometric variables. In conclusion, P Es are slightly greater in overweight and obese subjects than lean subjects; but changes with position are similar in both groups. These data indicate that mediastinal weight and postural effects on P Es are within a clinically acceptable range, and suggest that esophageal manometry can be used to inform clinical decision making across wide range of body types.
KW - esophageal pressure
KW - obese patients
KW - ventilator settings
UR - http://www.scopus.com/inward/record.url?scp=84870293883&partnerID=8YFLogxK
U2 - 10.1038/oby.2012.120
DO - 10.1038/oby.2012.120
M3 - Article
VL - 20
SP - 2354
EP - 2360
JO - Obesity
JF - Obesity
SN - 1930-7381
IS - 12
ER -