The utility of esophageal pressure measurement in non-invasive ventilation weaning in severe COPD exacerbation

Esophageal pressure (Pes) measurement provides a practical means of quantifying respiratory effort during invasive mechanical ventilation and can be used as a clinical tool for assessing patients during the weaning trial. There is little data regarding a similar use in patients with acute hypercapnic respiratory failure (AHRF) under NIV. We aimed to investigate the potential utility of Pes measurement in guiding NIV weaning during AHRF due to severe COPD exacerbation. Methods: A prospective cohort study was undertaken in a respiratory intermediate care unit in an academic medical center between 2018 and 2019. We measured ∆Pes daily, and we registered these values together with patient characteristics, ventilatory function, and other data. The outcome was successful NIV weaning as opposed to the need for home NIV. Our objective was to identify Pes characteristics that would correlate with successful NIV weaning or the need to continue NIV at home. Results: We included 15 patients (8 males, mean age 65 years) with severe COPD exacerbation with AHRF requiring NIV. All patients were successfully managed with NIV. 10 patients could be weaned from NIV and had an average decrease in ∆Pes from admission to discharge of 6.2 cmH2O (SD 3.0, p 0.07) with a mean discharge ∆Pes of 9.3 cmH2O (SD 4.1). 5 patients needed home NIV and had a medium decrease of ∆Pes of 2.5 cmH2O (SD 2.7, p 0.2) with a mean discharge ∆Pes of 15.0 (SD 1.0). Mean difference of ∆Pes at discharge between the 2 groups was 5.7 (p 0.08). Conclusion: In patients with severe COPD exacerbation with AHRF that required NIV, a lack of drop in ∆Pes and a higher discharge ∆Pes could predict a need for home NIV.