Esophageal pressure monitoring during mechanical ventilation in critically ill adult patients: A systematic review and meta-analysis

Abstract

Objective: To evaluate the effects of esophageal pressure monitoring in adult patients with mechanical ventilation requirements in the Intensive Care Unit.

Design: A systematic review (PROSPERO Register CRD42018118583) was carried out.

Setting: Intensive therapy. Critical care.

Patients or participants: Adults with mechanical ventilation requirement in the Intensive Care Unit.

Interventions: Esophageal pressure monitoring.

Outcomes of interest: Intensive Care Unit mortality and length of stay, mechanical ventilation days, adverse events.

Results: Four studies with 301 participants were included. Esophageal pressure monitoring during mechanical ventilation had little or no effect on mortality in intensive care at 28 days (RR 0.74; 95% CI 0.31-1.76; participants 261; studies 2; I²: 68%), with little or no differences in ICU length of stay (MD 0.48; 95% CI -1.90 to 2.85; participants 284; studies 3; I²: 7%) or impact upon adverse events (RR 0.74; 95% CI 0.50-1.09; participants 261; studies 2; I²: 0%). There is uncertainty about whether esophageal pressure monitoring reduces the duration of mechanical ventilation.

Conclusions: Evidence of low or very low certainty indicates that esophageal pressure monitoring during mechanical ventilation would produce little or no effect on Intensive Care Unit mortality, Intensive Care Unit length of stay, days on mechanical ventilation or adverse events.

Keywords: Esophageal pressure; Intensive Care Unit; Mechanical ventilation; Mortalidad; Mortality; Presión esofágica; Presión transpulmonar; Revisión sistemática; Systematic review; Transpulmonary pressure; Unidad de Cuidados Intensivos; Ventilación mecánica.