Sitting and supine esophageal pressures in overweight and obese subjects

Robert L Owens, Lisa M Campana, Lauren Hess, Danny J Eckert, Stephen H Loring, Atul Malhotra, Robert L Owens, Lisa M Campana, Lauren Hess, Danny J Eckert, Stephen H Loring, Atul Malhotra

Abstract

Esophageal pressure (P(Es)) can be used to approximate pleural pressure (P(pl)) and might be clinically useful, particularly in the obese e.g., to guide mechanical ventilator settings in critical illness. However, mediastinal artifact (the difference between true P(pl) and P(Es)) may limit acceptance of the measurement, and reproducibility of P(Es) measurements remains unknown. Therefore, we aimed to assess the effect of body posture on P(Es) in a cohort of obese, but healthy subjects, some of whom had multiple measurements, to address the clinical robustness of esophageal manometry. Twenty-five overweight and obese subjects (BMI > 25 kg/m(2)) and 11 control lean subjects (BMI < 25 kg/m(2)) underwent esophageal manometry with pressures measured seated and supine. Twenty overweight and obese subjects had measurements repeated after ~1 to 2 weeks. Anthropometric data and sitting and supine spirometry were recorded. The average end-expiratory P(Es) sitting and supine were greater in the overweight and obese group than the lean group (sitting -0.1 ± 2.1 vs. -3.3 ± 1.2 cm H(2)O, supine 9.3 ± 3.3 vs. 6.9 ± 2.8 cm H(2)O, respectively). The mean differences between repeated measurements were small (-0.3 ± 1.7 cm H(2)O sitting and -0.1 ± 1.5 cm H(2)O supine). P(Es) correlated with a number of anthropometric and spirometric variables. In conclusion, P(Es) are slightly greater in overweight and obese subjects than lean subjects; but changes with position are similar in both groups. These data indicate that mediastinal weight and postural effects on P(Es) are within a clinically acceptable range, and suggest that esophageal manometry can be used to inform clinical decision making across wide range of body types.

Figures

Figure 1
Figure 1
End expiratory esophageal pressure sitting and supine for each subject. Lean (▲) and overweight and obese (■), with each group mean in black.
Figure 2
Figure 2
Bland-Altman plots of end-expiratory esophageal pressures (sitting, A and supine, B) from two separate measurements. Solid line is bias, and dotted lines represent the 95% confidence interval.

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