Accuracy of esophageal pressure to assess transpulmonary pressure during mechanical ventilation

During passive mechanical ventilation, pressure applied to the respiratory system includes the pressure required to inflate the lung (trans-pulmonary pressure) and the chest wall (pleural pressure). Esophageal pressure has been proposed as a surrogate for pleural pressure but controversies exist on the way to derive the values required to calculate trans-pulmonary pressure. Ex-vivo lung perfusion has been proposed to optimize organ function before transplantation. These setting may therefore allow the comparison of values of trans-pulmonary pressure from the lungs outside the thorax (during the ex-vivo lung perfusion) with values obtained from the same lungs inside the thorax (after transplantation). We try to identify the method to derive esophageal pressure that provide the “in-vivo” assessment of trans-pulmonary pressure closer to the “ex-vivo” measurement of trans-pulmonary pressure.