{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T23:58:45Z","timestamp":1780617525681,"version":"3.54.1"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"JSPS KAKENHI","award":["JP18K08904"],"award-info":[{"award-number":["JP18K08904"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>It is important to evaluate the size of respiratory effort to prevent patient self-inflicted lung injury and ventilator-induced diaphragmatic dysfunction. Esophageal pressure (Pes) measurement is the gold standard for estimating respiratory effort, but it is complicated by technical issues. We previously reported that a change in pleural pressure (\u0394Ppl) could be estimated without measuring Pes using change in CVP (\u0394CVP) that has been adjusted with a simple correction among mechanically ventilated, paralyzed pediatric patients. This study aimed to determine whether our method can be used to estimate \u0394Ppl in assisted and unassisted spontaneous breathing patients during mechanical ventilation.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>The study included hemodynamically stable children (aged &lt;18 years) who were mechanically ventilated, had spontaneous breathing, and had a central venous catheter and esophageal balloon catheter in place. We measured the change in Pes (\u0394Pes), \u0394CVP, and \u0394Ppl that was calculated using a corrected \u0394CVP (c\u0394CVP-derived \u0394Ppl) under three pressure support levels (10, 5, and 0 cmH<jats:sub>2<\/jats:sub>O). The c\u0394CVP-derived \u0394Ppl value was calculated as follows: c\u0394CVP-derived \u0394Ppl = k \u00d7 \u0394CVP, where k was the ratio of the change in airway pressure (\u0394Paw) to the \u0394CVP during airway occlusion test.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Of the 14 patients enrolled in the study, 6 were excluded because correct positioning of the esophageal balloon could not be confirmed, leaving eight patients for analysis (mean age, 4.8 months). Three variables that reflected \u0394Ppl (\u0394Pes, \u0394CVP, and c\u0394CVP-derived \u0394Ppl) were measured and yielded the following results: -6.7 \u00b1 4.8, \u2212 -2.6 \u00b1 1.4, and \u2212 -7.3 \u00b1 4.5 cmH2O, respectively. The repeated measures correlation between c\u0394CVP-derived \u0394Ppl and \u0394Pes showed that c\u0394CVP-derived \u0394Ppl had good correlation with \u0394Pes (r = 0.84, p&lt; 0.0001).<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>\u0394Ppl can be estimated reasonably accurately by \u0394CVP using our method in assisted and unassisted spontaneous breathing children during mechanical ventilation.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0247360","type":"journal-article","created":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T18:30:01Z","timestamp":1614623401000},"page":"e0247360","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Estimation of change in pleural pressure in assisted and unassisted spontaneous breathing pediatric patients using fluctuation of central venous pressure: A preliminary study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2173-2492","authenticated-orcid":true,"given":"Nao","family":"Okuda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyako","family":"Kyogoku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Inata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanako","family":"Isaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazue","family":"Moon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Hatachi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Shimizu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muneyuki","family":"Takeuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,3,1]]},"reference":[{"key":"pone.0247360.ref001","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1164\/rccm.201703-0536OC","article-title":"Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes","volume":"197","author":"E Goligher","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0247360.ref002","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1164\/rccm.200304-489CP","article-title":"Ventilator-induced diaphragmatic dysfunction","volume":"169","author":"T Vassilakopoulos","year":"2004","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0247360.ref003","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/MCC.0000000000000597","article-title":"Impact of spontaneous breathing during mechanical ventilation in acute respiratory distress syndrome.","volume":"25","author":"T Yoshida","year":"2019","journal-title":"Curr Opin Crit Care"},{"key":"pone.0247360.ref004","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1164\/rccm.201605-1081CP","article-title":"Mechanical ventilation to minimize progression of lung Injury in acute respiratory failure","volume":"195","author":"L Brochard","year":"2017","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0247360.ref005","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1164\/rccm.201903-0596SO","article-title":"Respiratory drive in critically ill patients. 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