Pleural Pressure Working Group
PROMOTING MONITORING IN RESPIRATORY FAILURE
Pen and ink drawing of Antoine Lavoisier performing a respiration experiment while his wife takes note
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 is a working group of the European Society of Intensive Care Medicine (ESICM) that was created by Dr. Laurent Brochard in 2012. 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, electromyogram, 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
Participation at ESICM summer conferences
Creation of educational tools
Chair: Laurent Brochard, Toronto, Canada
Jordi Mancebo, Barcelona, Spain
Tommaso Mauri, Milano, Italy
Chair: Daniel Talmor, Boston, US
Ewan Goligher, Toronto, Canada
Claude Guerin, Lyon, France
Leo Heunks, Amsterdam, The Netherland
Stefano Nava, Bologna, Italy
Chair: Jean-Michel Arnal, Toulon, France
Davide Chiumello, Milano, Italy
Alberto Goffi, Toronto, Canada
Francesco Mojoli, Pavia, Italy
Oriol Roca, Barcelona, Spain
Lisanne Roesthuys, Nijmegen, The Netherland
Carlo Alberto Volta, Ferrara, Italy
2nd ONLINE PLUG MEETING
Critical Care Canada Forum (CCCF)
October 5th, 2020 - 11:15-14:00 (Toronto); 17:15-20:00 (Central Europe); 23:15-02:00 (Beijing)
1st ONLINE PLUG MEETING
“Respiratory physiology of COVID-19 patients”
Wednesday April 29th, 9:00 am (Eastern Time); 15:00 (Central European Time)
CRITICAL CARE CANADA FORUM (CCCF) 2019 - criticalcarecanada.com
11th November 2019
2019 ESICM LIVES Meeting
30th September 2019
29th ARGENTINIAN MEETING OF INTENSIVE CARE MEDICINE -
4th-6th September 2019
41st ANNUAL MEETING OF THE JAPANESE SOCIETY FOR RESPIRATORY CARE
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.
ESICM Paris Meeting 2018
RecruitmEnt assessed by eleCtRical impedance tomography: feasibility, correlation with clinical oUtcomes and pIloT data on personalized PEEP selection: RECRUIT project
The RECRUIT study is a multicenter physiological observational study associated with specific lung (de)recruitment maneuvers
to verify the feasibility of measuring the potential for lung recruitment in ARDS by electrical impedance tomography (EIT)
to describe the range of lung recruitability in ARDS
to develop methods for real-time and personalized PEEP selection based on EIT
to assess the association between PEEP selection by EIT-based methods and the potential for lung recruitment
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.
Laurent Brochard (firstname.lastname@example.org)
Link to clinicaltrials.gov
Incidence of dyssynchronous spontaneous Breathing Effort, breath-stacking and reverse triggering in early ARDS -
The BEARDS project -
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.
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.
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).
To understand the relationship between sedation levels and regimens and the different types of dyssynchronies.
Link to clinicaltrials.gov
PRessure suppOrT vEntilation + Sigh in aCuTe hypoxemIc respiratOry failure patieNts (PROTECTION): a pilot randomized controlled trial
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.
Completed - Manuscript submitted
Tommaso Mauri (email: email@example.com)
Laurent Brochard (email: )
Link to clinicaltrials.gov
Work in progress... more videos to come
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.
Interested in publications or websites that may assist in the management and monitoring of patients with respiratory failure? Click on the icons below!
Do you have any recommendation for a publication or a website you think we should add to the list? Email us at:
The PLUG group meets regularly during international intensive care medicine conferences.