Esogastric pressure measurement to assist noninvasive ventilation indication and settings in infants with hypercapnic respiratory failure: A pilot study.

OBJECTIVE: Noninvasive ventilation (NIV) in usually set on clinical parameters. The aim of the study was to assess the value of esophageal (PES ) and gastric pressure (PGAS ) measurements for the indication and optimal settings of NIV in infants with hypercapnic respiratory failure in whom the efficacy of NIV was uncertain on clinical noninvasive parameters.

DESIGN: A retrospective study.

PATIENT-SUBJECT SELECTION: PES and PGAS measurements were performed in seven infants <2 years old admitted in the Pediatric Intensive Care Unit for an acute or acute-on-chronic hypercapnic respiratory failure.

METHODOLOGY: PES swing and esophageal pressure time product (PTPES ) during spontaneous breathing, NIV set on clinical parameters (NIVclin) and on PES (NIVphys) were compared. According to the PES measurements, NIV was continued if NIV was associated with an at least 20% reduction of the PES swing and PTPES and not initiated or withdrawn in the other case.

RESULTS: In all seven patients, the PES and PGAS measurements were informative and led to the decision to initiate NIV in one patient or continue NIV with different settings in three patients. In the three other patients, NIV was not initiated in one patient and withdrawn in the two last patients because of a lack of improvement in PES swing and PTPES .

CONCLUSIONS: PES and PGAS measurements may be useful for the indication and optimal setting of NIV in a selected group of infants with hypercapnic respiratory failure.