CARDIOPULMONARY MONITORING: Edited by Jean-Louis TeboulEsophageal pressure monitoring: why, when and how?Yoshida, Takeshia,b; Brochard, Laurenta,b Author Information aKeenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital bInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada Correspondence to Laurent Brochard, MD, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8. Tel: +1 416 864 5686; e-mail: [email protected] Current Opinion in Critical Care: June 2018 - Volume 24 - Issue 3 - p 216-222 doi: 10.1097/MCC.0000000000000494 Buy Metrics Abstract Purpose of review Esophageal manometry has shown its usefulness to estimate transpulmonary pressure, that is lung stress, and the intensity of spontaneous effort in patients with acute respiratory distress syndrome. However, clinical uptake of esophageal manometry in ICU is still low. Thus, the purpose of review is to describe technical tips to adequately measure esophageal pressure at the bedside, and then update the most important clinical applications of esophageal manometry in ICU. Recent findings Each esophageal balloon has its own nonstressed volume and it should be calibrated properly to measure pleural pressure accurately: transpulmonary pressure calculated on absolute esophageal pressure reflects values in the lung regions adjacent to the esophageal balloon (i.e. dependent to middle lung). Inspiratory transpulmonary pressure calculated from airway plateau pressure and the chest wall to respiratory system elastance ratio reasonably reflects lung stress in the nondependent ‘baby’ lung, at highest risk of hyperinflation. Also esophageal pressure can be used to detect and minimize patient self-inflicted lung injury. Summary Esophageal manometry is not a complicated technique. There is a large potential to improve clinical outcome in patients with acute respiratory distress syndrome, acting as an early detector of risk of lung injury from mechanical ventilation and vigorous spontaneous effort. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.