Comparación entre diferentes métodos de evaluación de la presión transdiafragmática. Utilidad en pacientes con EPOC

Gea, J.; Aran, X.; Orozco-Levi, M.; Sauleda, J.; Aguar, M.C.; Broquetas, J.M.

doi:10.1016/S0300-2896(15)31183-2

Archivos de Bronconeumología

ISSN: 0300-2896

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Vol. 29. Issue 7.

Pages 328-331 (October 1993)

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Pages 328-331 (October 1993)

DOI: 10.1016/S0300-2896(15)31183-2

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Comparación entre diferentes métodos de evaluación de la presión transdiafragmática. Utilidad en pacientes con EPOC

Comparison between different methods of evaluation of transdiaphragmatic pressure. Use in patients with COPD

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J. Gea*, X. Aran, M. Orozco-Levi, J. Sauleda, M.C. Aguar, J.M. Broquetas

Servicio de Neumología. Hospital del Mar. Universidad Autónoma de Barcelona (UAB). Instituto Municipal de Investigación Médica (IMIM). Barcelona

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Los valores de presión esofágica (Pes), gástrica (Pga) y transdiafragmática (Pdi) se pueden obtener por varios métodos. El de referencia es calcular su valor medio por planimetría de la curva. Como alternativas se han propuesto el valor medio obtenido por cuadratura y el valor máximo (“pico”). Las tres técnicas se comparan en 12 pacientes con EPOC. La cuadratura mostró Pes similares a la planimetría (-11,2 ± 1,0 vs -11,6 ± 1,1 cmH2O, NS), aunque las Pga fueron algo inferiores (3,8 ± 0,5 frente a 4,2 ± 0,5 cmH2O, p < 0,05). Sólo en 3 curvas de Pga pudo efectuarse la cuadratura; en el resto se calculó el área geométricamente. La diferencia en las Pga se expresó en las Pdi (15,0 ± 1,2 cmH2O frente a 15,8 ± 1,2; p < 0,05), pero desapareció para Pdi/Pdimax y TTdi. Las P pico (Pes -15,2 ± 1,1, Pga 8,2 ± 1,0 y Pdi 23,4 ± 1,7 cmH2O) fueron muy superiores a las P medias. La transformación cuadrática constituye una buena alternativa para la determinación de la Pes en pacientes con EPOC, aunque es menos útil para la Pga. Las P pico no debieran utilizarse.

The values of esophageal (Pes), gastric (Pga) and transdiaphragmatic (Pdi) pressure may be obtained by several methods. That of reference is to calculate their mean values by curve planimetry. The mean value obtained by squaring and the maximum value (peak) have been proposed as alternatives. The three techniques were compared in 12 patients with COPD. Squaring demostrated similar Pes to that of planimetry (-11.2 ± 1.0 vs -11.6 ± 1.1 cmH2O, NS) although the Pga were somewhat lower (3.8 ± 0.5 vs 4.2 ± 0.5 cmH2O, p < 0.05). Squaring could only be performed in 3 Pga curves, in the remaining the area was calculated geometrically. The difference in the Pga was expressed in the Pdi (15.0 ± 1.2 cmH2 vs 15.8 ± 1,2; p < 0.05) but disappeared for Pdi/Pdimax and TTdi. The P peak (Pes -15.2 ± 1.1, Pga 8.2 ± 1.0 and Pdi 23.4 ±1.7 cmH2O) were much higher than the mean pressures. Square transformation constitutes a good alternative for the determination of Pes in patients with COPD although it is less useful for the Pga. The P peak should not be used.

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