8 thoughts on “Airway occlusion pressure (P0.1)”

  1. Thank you for these educational cases. I’m curious about the first case you showed with a P0.1 of -6cmH2O which suggested a high respiratory drive. If you determined the plateau pressure in this patient to be safe (<25 or <30 or whatever you would deem to be acceptable) how would this change your management assuming that you do not have access to an esophageal manometer?

    Would you be reassured by the safe plateau pressure and accept this "high ventilatory drive" and thus maintain the patient on the current level of sedation?

    Or would you suspect that the high respiratory drive translates to more negative pleural pressure and thus increased transpulmonary pressure to a potentially dangerous level?…thereby prompting you to increase sedation/consider neuromuscular blockade… This seems like too far of a stretch given the unknown effects of respiratory system compliance and other factors without the esophageal pressure.

    1. Respiratory drive levels like this are associated with weaning failure. To have this type of drive while a patient is receiving full ventilation we feel should be concerning based on the clinical context (ie. patients course in ICU, the presence of ARDS, oxygen and PEEP requirements), and the risk of patient self-inflicted lung injury (P-SILI). Esophageal pressure is always valuable, but currently, we know P0.1 is a validated representation of respiratory drive, and levels of ~6 cmH2O are associated with weaning failure. If they have no underlying reason (chronic lung disease) for a high respiratory drive such as this, you have to weigh the potential injury risks (including oxygen consumption) with benefits of allowing patients to continue making spontaneous efforts. One method for reducing drive without affecting rate is careful titration of propofol, this may be considered rather than paralysis depending on the clinical condition. As for plateau, consider that patients in volume control can maintain transpulmonary pressure (PL) because airway pressure drops with increased effort. However, pendelluft can occur causing regional lung stress that is independent of PL

    1. Generally, yes. But if increasing PSV cannot reduce the P0.1 to an acceptable value we consider risk of self-inflicted injury.

      1. Do you find important titrate PS in PSV by P01 value, between -1,5 to -3,5 to protect diafragm and avoiding over ir under assist of the parient.

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