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Esophageal Balloon Monitoring: Understanding Respiratory Physiology Beyond Airway Pressure

Airway pressure alone does not tell the whole story.

Understanding how pleural pressure, transpulmonary pressure, respiratory effort, and chest wall mechanics interact is fundamental for delivering truly personalized mechanical ventilation.

In this month's Journal Club, we recommend an outstanding review published in the European Respiratory Review, which summarizes the physiological principles, practical aspects, and current clinical applications of esophageal balloon monitoring in mechanically ventilated patients.

Throughout the article, the authors explain how esophageal pressure monitoring can help clinicians:

✔ Differentiate lung and chest wall mechanics

✔ Optimize PEEP based on transpulmonary pressure

✔ Quantify inspiratory effort

✔ Assess patient–ventilator interaction

✔ Better understand lung stress during controlled and assisted ventilation

In addition to reviewing the physiological concepts, the paper provides a practical bedside approach for catheter placement, validation using the occlusion test, and interpretation of measurements in everyday clinical practice.

Whether you are involved in critical care, respiratory physiology, or mechanical ventilation education, this review is an excellent resource to strengthen the physiological reasoning behind ventilator management.

🫁Recommended for: intensivists, respiratory therapists, physiotherapists, anesthesiologists, fellows, residents, and anyone interested in advanced respiratory monitoring.

🔗 Jonkman AH, Telias I, Spinelli E, Akoumianaki E, Piquilloud L. The oesophageal balloon for respiratory monitoring in ventilated patients: updated clinical review and practical aspects. Eur Respir Rev. 2023 May 17;32(168):220186. doi: 10.1183/16000617.0186-2022. 

Happy reading!