Erroneous calibration of esophageal pressure in case of airway closure
Bibliographic record
Abstract
Airway closure results in a lack of communication between proximal and distal airways unless the airway pressure (Paw) overcomes the airway opening pressure (AOP). This has been described in patients undergoing mechanical ventilation with acute respiratory distress syndrome, obesity, hydrostatic pulmonary edema and during cardiopulmonary resuscitation. In these categories of patients, esophageal pressure (Pes) can guide the personalization of mechanical ventilation and calibration of the esophageal balloon is necessary to obtain reliable Pes measurements. The impact of airway closure has never been envisaged. This study investigated the impact of airway closure on the calibration of the esophageal balloon by the ∆Paw/∆Pes following a positive pressure occlusion test during passive mechanical ventilation. The calibration test was performed in twelve human cadavers with airway closure at end-expiration at different levels of positive end-expiratory pressure (PEEP) and at end-inspiration. The ∆Paw/∆Pes measured at end-expiration and at end-inspiration were significantly different when total PEEP was lower than AOP (estimated means 0.42 [0.40; 0.44] vs. 0.95 [0.92; 0.97], P < 0.001), while this difference was not observed when total PEEP was higher than AOP (estimated means 0.99 [0.92; 1.05] vs. 0.99 [0.92; 1.06], P = 0.854). These results were corroborated by observations during esophageal balloon calibration in two patients requiring Pes monitoring for clinical management. In case of airway closure, compression of the chest is not fully transmitted to the airways. This can lead to a conspicuous underestimation of the ∆Paw/∆Pes and poor reliability of this monitoring technique when the test takes place below AOP. Our results favor a positive pressure occlusion test performed during an end-inspiratory occlusion as the new standard of operative procedures for positioning and calibrating the esophageal balloon.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".