Image-Guided Percutaneous Technique for Direct Pleural Pressure Measurement in a Swine Model

Andrea Restivo; Michele Delle Vergini; Genevieve McCormack; Marcus Victor; Glasiele Alcala; Elisa Mereto; Davide Raimondi Cominesi; Gaurang Amonkar; Emanuele Rezoagli; Yi Xin; Maurizio Cereda

doi:10.3791/71506

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Method Article

Image-Guided Percutaneous Technique for Direct Pleural Pressure Measurement in a Swine Model

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DOI:

10.3791/71506

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August 28th, 2026

Andrea Restivo¹^,² , Michele Delle Vergini¹^,² , Genevieve McCormack¹ , Marcus Victor³ , Glasiele Alcala⁴^,⁵ , Elisa Mereto¹^,⁶ , Davide Raimondi Cominesi²^,⁷ , Gaurang Amonkar¹ , Emanuele Rezoagli² , Yi Xin¹ , Maurizio Cereda¹

¹Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, ²School of Medicine and Surgery, University of Milano-Bicocca, ³Electronics Engineering Division, Aeronautics Institute of Technology, ⁴Department of Medicine, Division of Respirology, University Health Network, ⁵Unidade de Terapia Intensiva Respiratoria, Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, ⁶Department of Pathophysiology and Transplantation, University of Milan, ⁷Keenan Research Center, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto

Summary

This protocol describes a minimally invasive percutaneous technique for inserting anterior and posterior pleural catheters in swine, enabling direct measurement of regional pleural pressure without thoracotomy.

Abstract

Pleural pressure measurement enables advanced physiologic assessment, including partitioning respiratory system mechanics into lung and chest wall components, calculating transpulmonary pressure, and quantifying regional pleural pressure gradients. This information is essential for optimizing mechanical ventilation, assessing the impact of altered chest wall physiology, and advancing translational research in lung injury. However, current techniques for direct pleural pressure measurement often require open-chest surgical implantation of pleural pressure transducers via thoracotomy, which is time-consuming, high-risk, and may impair chest wall mechanics. To overcome these limitations, we developed a minimally invasive, percutaneous, image-guided technique for pleural catheter placement. The procedure was performed in anesthetized, mechanically ventilated swine. Under ultrasound guidance, a Tuohy needle was advanced into the pleural space, and a small artificial pneumothorax (50–100 mL of oxygen) was created to separate the pleural layers. Over a guidewire, a 9 Fr sheath introducer was placed, allowing advancement of a balloon-tipped catheter into the anterior pleura. The animal was then turned in a semiprone position, and a second catheter was inserted dorsally after increasing the same pneumothorax by an additional 50–100 mL of oxygen. Placement was confirmed by computed tomography (CT) and physiologic tracings. After evacuation of the pneumothorax and lung re-expansion, imaging verified the position. Successful anterior and posterior catheter placement was achieved in 16 of 20 animals (80%), supporting the procedural feasibility of this approach. Unsuccessful procedures were due to unintended pneumothorax during anterior pleural access or anterior catheter malposition outside the target ventral region. This method provides a less invasive and reproducible approach for direct regional pleural pressure monitoring in large-animal models. By avoiding surgical access, this percutaneous, image-guided technique is well-suited for experimental protocols investigating respiratory mechanics, lung and chest wall physiology, and mechanical ventilation in translational research.

Introduction

Pleural pressure has been widely used in experimental studies as a key indicator of chest wall mechanics, helping to describe the partitioned behavior of the respiratory system and its interaction with the lung during mechanical ventilation¹. This variable is essential for calculating transpulmonary pressure, which represents the primary determinant of lung stress². In lung injury, pleural pressure can also help describe end-expiratory mechanics and provide insight into the superimposed pressure gradient, a phenomenon linked to the load acting on dependent lung regions³^,