机构：[1]Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.诊疗科室重症医学科（ICU）首都医科大学附属天坛医院[2]the Intensive Care Unit, Beijing Electric Power Hospital, Capital Medical University, Beijing, China.
BACKGROUND: The dynamic occlusion test is used to guide balloon catheter placement during esophageal pressure (P-es) monitoring. We introduced a cardiac cycle locating method to attenuate the influence of cardiac artifacts on Pes measurement. The aim was to provide a reliable analytic algorithm for the occlusion test. METHODS: Esophageal balloon catheters were placed in subjects receiving pressure support ventilation. During balloon position adjustment, end-expiratory occlusion was performed to induce 3 consecutive inspiratory efforts. Pes and airway pressure (P-aw) data were collected for off-line analysis. For each occluded inspiratory effort, the change in Pes (Delta P-es) was plotted against the change in Paw (Delta P-aw), and the slope of the regression line was calculated. The Delta P-es/Delta P-aw ratio was also measured with the cardiac cycle locating method and peak-to-peak method. Bland-Altman analysis was used to assess the agreement between the Delta P-es/Delta P-aw ratio and the slope. We defined the occlusion test with all fitted slopes for the 3 inspiratory efforts within 0.8 to 1.2 to indicate optimal balloon position; otherwise, the position was deemed non-optimal. Using the slope as the reference, the diagnostic accuracy of the Delta P-es/Delta P-aw ratio in distinguishing the optimal and the non-optimal balloon position was analyzed. RESULTS: A total of 86 occlusion tests containing 258 inspiratory efforts were collected from 15 subjects. The median (interquartile range) slope of Delta P-es versus Delta P-aw plot was 0.85 (0.76, 0.91). Bias (lower and upper limit of agreement) of Delta P-es/Delta P-aw ratio measured by the cardiac cycle locating method and the peak-to-peak method was 0.02 (-0.13 to 0.16) and 0.06 (-0.18 to 0.31), respectively. Forty-five (52.3%) occlusion tests indicated optimal balloon positions. Compared to the peak-to-peak method, the cardiac cycle locating method was more specific in detecting the non-optimal position. CONCLUSIONS: The cardiac cycle locating method provided reliable and precise measurement for the occlusion test. This method can accurately detect non-optimal balloon position during catheter adjustment.
基金：
This prospective observational study was conducted in the ICU of Beijing Tiantan Hospital, Capital Medical University, Beijing, China. The study protocol was reviewed and approved by the local institutional review board (KY2016-019-02). Written informed consent was obtained from subjects or appropriate substitute decision makers. This study was supported by grants from Special Program of Beijing Municipal Science and Technology Commission (Z161100000116081). The sponsor had no role in the study design, data collection, data analysis, data interpretation, or writing of the report.
第一作者机构：[1]Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
通讯作者：
通讯机构：[1]Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.[*1]Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, Dongcheng District, 100050, Beijing, China.
推荐引用方式(GB/T 7714)：
He Xuan,Sun Xiu-Mei,Chen Guang-Qiang,et al.Use of Cardiac Cycle Locating to Minimize the Influence of Cardiac Artifacts on Esophageal Pressure Measurement During Dynamic Occlusion Test[J].RESPIRATORY CARE.2018,63(2):169-176.doi:10.4187/respcare.05750.
APA：
He, Xuan,Sun, Xiu-Mei,Chen, Guang-Qiang,Yang, Yan-Lin,Shi, Zhong-Hua...&Zhou, Jian-Xin.(2018).Use of Cardiac Cycle Locating to Minimize the Influence of Cardiac Artifacts on Esophageal Pressure Measurement During Dynamic Occlusion Test.RESPIRATORY CARE,63,(2)
MLA：
He, Xuan,et al."Use of Cardiac Cycle Locating to Minimize the Influence of Cardiac Artifacts on Esophageal Pressure Measurement During Dynamic Occlusion Test".RESPIRATORY CARE 63..2(2018):169-176
