the PLUG

GROUP

Pleural Pressure Working Group

PROMOTING MONITORING IN RESPIRATORY FAILURE

Dear colleagues and members,

 

It is with great sadness that we announce the death of our dear friend and colleague

Jordi Mancebo. He passed away on the night of August 6th.

 

Jordi was a co-founder of the PLUG and this group was very dear to his heart especially regarding the transmission to the next generation.

 

We'll miss him enormously.

 

Laurent Brochard,

Tommaso Mauri

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Solidarity with Ukraine

Link to ESICM statement 

Pen and ink drawing of Antoine Lavoisier performing a respiration experiment while his wife takes note

PUBLIC DOMAIN

 

WHO

WE ARE

The Pleural Pressure Working Group (PLUG) is an international network of physicians and investigators working on advanced monitoring of mechanical ventilation and respiratory failure. Our goal is to promote research and use of advanced monitoring, discuss study results, and provide educational tools. PLUG working group is open to anybody interested in this topic and is independent from any manufacturer or private company.

PLUG has been created as a working group of the European Society of Intensive Care Medicine (ESICM) by Dr. Laurent Brochard in 2012 and became an independent group in 2021. The first focus was to promote research and use of esophageal pressure in mechanically ventilated patients. The focus was later extended to advance monitoring including electrical impedance tomography, lung ultrasound, electromyography, etc.

The group gathers more than 140 members from all over the world. The organization is structured in an executive committee, a scientific committee and an educational committee.

The main activities of the PLUG working group are:

  • Publication of review articles about esophageal pressure monitoring and other advanced monitoring techniques in respiratory failure. The PLUG members published numerous research articles

  • Organization of multicenter trials

  • Organization of scientific meetings throughout the year in Europe and North America

  • Creation of educational tools

Executive committee:

Chair: Laurent Brochard, Toronto, Canada

Jordi Mancebo, Barcelona, Spain

Tommaso Mauri, Milano, Italy

 

Scientific committee:

Chair: Daniel Talmor, Boston, US

Ewan Goligher, Toronto, Canada

Claude Guerin, Lyon, France

Leo Heunks, Amsterdam, The Netherlands

Stefano Nava, Bologna, Italy

 

Educational committee:

Chair: Jean-Michel Arnal, Toulon, France

Davide Chiumello, Milano, Italy

Alberto Goffi, Toronto, Canada

Francesco Mojoli, Pavia, Italy

Oriol Roca, Barcelona, Spain

Lisanne Roesthuis, Nijmegen, The Netherlands

Carlo Alberto Volta, Ferrara, Italy

MEETINGS

Past meetings
PLUG ONLINE - April 20, 2022  


4th ONLINE PLUG MEETING
October 25 and November 8, 2021, Online 

GO TO VIDEOS 

ESICM PLUG THEMATIC SESSION

October 3-6, 2021, Online 
Search in the ESICM program for the session 'PLUG: novelties in respiratory physiology of the critically ill'
 
3rd ONLINE PLUG MEETING
April 16th, 2021, Online
ESICM ARF SECTION MEETING
December 8th, 2020, Online
2nd ONLINE PLUG MEETING
Critical Care Canada Forum (CCCF)
October 5th, 2020, Online
 

1st ONLINE PLUG MEETING

“Respiratory physiology of COVID-19 patients”

April 29th, 2020, Online 

CRITICAL CARE CANADA FORUM (CCCF) 2019 - criticalcarecanada.com

Toronto, Canada

11th November 2019 

2019 ESICM LIVES Meeting

Berlin, Germany

30th September 2019 

29th ARGENTINIAN MEETING OF INTENSIVE CARE MEDICINE 

Mendoza, Argentina

4th-6th September 2019

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GO TO VIDEOS

41st ANNUAL MEETING OF THE JAPANESE SOCIETY FOR RESPIRATORY CARE 

Osaka, Japan

3rd-4th August 2019

LUNG and DIAPHRAGM-PROTECTIVE

VENTILATION CONSENSUS CONFERENCE

MiCo Milano, Milan, Italy

6th-8th May 2019

Members of the Pleural Pressure Working Group gathered from around the world for a state-of-the-art meeting on an important new challenge in the management of patients with acute respiratory failure: integrating the traditional focus on lung-protective ventilation with the emerging paradigm of diaphragm-protective mechanical ventilation. The meeting involved two days of extensive discussion and debate about the best available mechanistic and clinical evidence supporting various facets of lung and diaphragm-protective ventilation strategies. Over the two days, a genuine consensus emerged over the importance of addressing the new issues raised and the need for advances in monitoring and intervention to target mechanisms of lung and diaphragm injury during ventilation. Participants agreed that the meeting was a great success; in particular, it was a phenomenal opportunity for junior investigators in the field to interact with more established leaders. The importance of this meeting for clinical practice and for research in the field will emerge over years to come.

Results from the two-day discussion have now been published on the Am J Respir Crit Care Med. The manuscript discusses how the current approach to mechanical ventilation might be revised to prevent ventilator-induced diaphragm atrophy, injury, and resulting weakness while maintaining lung-protective ventilation, an approach we refer to as lung and diaphragm-protective ventilation. 

https://www.atsjournals.org/doi/abs/10.1164/rccm.202003-0655CP

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ESICM Paris Meeting 2018
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RESEARCH

RecruitmEnt assessed by eleCtRical impedance tomography: feasibility, correlation with clinical oUtcomes and pIloT data on personalized PEEP selection: RECRUIT project

Objectives

The RECRUIT study is a multicenter physiological observational study associated with specific lung (de)recruitment maneuvers

  1. to verify the feasibility of measuring the potential for lung recruitment in ARDS by electrical impedance tomography (EIT)

  2. to describe the range of lung recruitability in ARDS

  3. to develop methods for real-time and personalized PEEP selection based on EIT

  4. to assess the association between PEEP selection by EIT-based methods and the potential for lung recruitment

  5. to explore the association between potential for lung recruitment, clinical PEEP setting and clinical course of ARDS in the first week after the test and 28-day mortality

Duration of study measurements: 1.5-2 hours on a single day.

Current status

Recruiting

Principal investigators

Laurent Brochard (laurent.brochard@unityhealth.to)

Tommaso Mauri

Marcelo Amato

Link to clinicaltrials.gov

Incidence of dyssynchronous spontaneous Breathing Effort, breath-stacking and reverse triggering in early ARDS -

The BEARDS project -

Objectives

  1. To describe the incidence of spontaneous breathing efforts, reverse triggering, breath stacking and short cycles, as well as other asynchronies like wasted efforts in the first week of ARDS and AHRF.

  2. To analyze the presence of main dyssynchronies with its corresponding changes in transpulmonary pressure swings, plateau pressure and volume delivered by the ventilator in those breaths, and quantify the breathing efforts generated.

  3. To associate the incidence of dyssynchronies (including reverse triggering) during the early phase of ARDS and AHRF, with outcome (ventilator free days, intensive care unit (ICU) stay, mortality, pneumothorax as secondary outcome).

  4. To understand the relationship between sedation levels and regimens and the different types of dyssynchronies.

Current status

Completed

Principal investigator

Laurent Brochard

email: laurent.brochard@unityhealth.to

Link to clinicaltrials.gov

PRessure suppOrT vEntilation + Sigh in aCuTe hypoxemIc respiratOry failure patieNts (PROTECTION): a pilot randomized controlled trial 

Objective

This pilot RCT will serve to test the hypothesis that application of PSV+Sigh in spontaneously breathing intubated patients with mild to moderate AHRF and ARDS is feasible and to collect preliminary data on the safety of such an approach.

Current status

Completed 

Principal investigators

Tommaso Mauri (email: tommaso.mauri@unimi.it)

Laurent Brochard (email: brochardl@smh.ca)

Link to clinicaltrials.gov

  

 

VIDEOS

01. How to measure driving and transpulmonary driving pressure

03. How to inflate the esophageal balloon

05. How to insert the esophageal balloon

07. How to measure

PEEPi

09. How to measure

transpulmonary pressure

in a passive patient

02. How to recruit the lung with transpulmonary pressure

04. The different pressure in the thorax

06. How to calculate

WOB & PTP

08. How to set PEEP

using transpulmonary pressure

10. Why measuring esophageal pressure in a spontaneously breathing patient?

11. How to perform esophageal manometry in children

 

OUR BLOG

Click on "YOUR STORIES - The PLUG" button and you will be able to ask question, post comments, upload interesting cases you want to share with the PLUG community. 

BLOG
YOUR STORIES
 

RESOURCES

& PUBLICATIONS

Interested in publications or websites that may assist in the management and monitoring of patients with respiratory failure? Click on the icons below!

GO TO PUBLICATIONS
PUBLICATIONS
GO TO
ONLINE RESOURCES
ONLINE RESOURCES

Do you have any recommendation for a publication or a website you think we should add to the list? Email us at: plug.workinggroup@gmail.com

 
Marble Surface

IN MEMORIAM

Brian Kavanagh, 1962 to 2019

Robert Kacmarek, 1949 to 2021

 

Göran Hedenstierna, 1941 to 2021

Joseph Milic-Emili, 1931 t0 2022

EVENTS

The PLUG group meets regularly during international intensive care medicine conferences.

 

NUMBERS

140

MEMBERS

5

PUBLICATIONS

4

MEETINGS
EVERY YEAR
 
 

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