Journal of Applied Physiology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
 QUICK SEARCH:   [advanced]


     


J Appl Physiol (November 23, 2005). doi:10.1152/japplphysiol.00697.2005
This Article
Right arrow Full Text (PDF) Free
Right arrow All Versions of this Article:
100/3/753    most recent
00697.2005v1
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Washko, G. R.
Right arrow Articles by Loring, S. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Washko, G. R.
Right arrow Articles by Loring, S. H.
Submitted on June 14, 2005
Accepted on November 16, 2005

Volume-related and volume independent effects of posture on esophageal and transpulmonary pressures in healthy subjects

George R. Washko1, Carl R. O'Donnell1, and Stephen H. Loring2*

1 Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
2 Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA

* To whom correspondence should be addressed. E-mail: sloring{at}bidmc.harvard.edu.

Ventilator management decisions in acute lung injury could be better informed with knowledge of the patient's transpulmonary pressure, which can be estimated using measurements of esophageal pressure. Esophageal manometry is seldom used for this, however, in part because of a presumed postural artifact in the supine position. Here, we characterize the magnitude and variability of postural effects on esophageal pressure in healthy subjects to better assess its significance in patients with acute lung injury. We measured the posture-related changes in relaxation volume (Vrel) and total lung capacity (TLC) in 10 healthy subjects in 4 postures: upright, supine, prone, and left lateral decubitus. Then, in the same subjects, we measured static pressure-volume characteristics of the lung over a wide range of lung volume in each posture using an esophageal balloon-catheter. Transpulmonary pressure during relaxation (PL,rel) averaged 3.7 ± 2.0 cm H2O upright and -3.3 ± 3.2 cm H2O supine. Approximately 58% of the decrease in PL,rel between the upright and supine postures was due to a corresponding decrease in Vrel. The remaining 2.9 cm H2O difference is consistent with reported values of a presumed postural artifact. Relaxation volumes and pressures in prone and lateral postures were intermediate. To correct estimated transpulmonary pressure for the effect of lying supine, we suggest adding 3 cm H2O (95% C.I. -1 to +7 cm H2O). We conclude that postural differences in estimated transpulmonary pressure at a given lung volume are small when compared with the substantial range of PL,rel in patients with acute lung injury.




This article has been cited by other articles:


Home page
ChestHome page
J. A. Fiz, J. Gnitecki, S. S. Kraman, G. R. Wodicka, and H. Pasterkamp
Effect of Body Position on Lung Sounds in Healthy Young Men
Chest, March 1, 2008; 133(3): 729 - 736.
[Abstract] [Full Text] [PDF]


Home page
ChestHome page
S. H. Loring, C. R. O'Donnell, D. J. Feller-Kopman, and A. Ernst
Central Airway Mechanics and Flow Limitation in Acquired Tracheobronchomalacia
Chest, April 1, 2007; 131(4): 1118 - 1124.
[Abstract] [Full Text] [PDF]




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Visit Other APS Journals Online
Copyright © 1948 by the American Physiological Society.