Role of Positive End-Expiratory Pressure and Regional Transpulmonary Pressure in Asymmetrical Lung Injury

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dc.contributor.authorBastia, Luca
dc.contributor.authorEngelberts, Doreen
dc.contributor.authorOsada, Kohei
dc.contributor.authorKatira, Bhushan H.
dc.contributor.authorDamiani, L. Felipe
dc.contributor.authorYoshida, Takeshi
dc.contributor.authorChen, Lu
dc.contributor.authorFerguson, Niall D.
dc.contributor.authorAmato, Marcelo B. P.
dc.contributor.authorPost, Martin
dc.contributor.authorKavanagh, Brian P.
dc.contributor.authorBrochard, Laurent
dc.date.accessioned2025-01-20T23:50:47Z
dc.date.available2025-01-20T23:50:47Z
dc.date.issued2021
dc.description.abstractRationale: Asymmetrical lung injury is a frequent clinical presentation. Regional distribution of V-T and positive end-expiratory pressure (PEEP) could result in hyperinflation of the less-injured lung. The validity of esophageal pressure (Pes) is unknown.
dc.description.abstractObjectives: To compare, in asymmetrical lung injury, Pes with directly measured pleural pressures (Ppl) of both sides and investigate how PEEP impacts ventilation distribution and the regional driving transpulmonary pressure (inspiratory - expiratory).
dc.description.abstractMethods: Fourteen mechanically ventilated pigs with lung injury were studied. One lung was blocked while the contralateral one underwent surfactant lavage and injurious ventilation. Airway pressure and Pes were measured, as was Ppl in the dorsal and ventral pleural space adjacent to each lung. Distribution of ventilation was assessed by electrical impedance tomography. PEEP was studied through decremental steps.
dc.description.abstractMeasurements and Results: Ventral and dorsal Ppl were similar between the injured and the noninjured lung across all PEEP levels. Dorsal Ppl and Pes were similar. The driving transpulmonary pressure was similar in the two lungs. VT distribution between lungs was different at zero end-expiratory pressure (similar to 70% of VT going in noninjured lung) owing to different respiratory system compliance (8.3 ml/cm H2O noninjured lung vs. 3.7 ml/cm H2O injured lung). PEEP at 10 cm H2O with transpulmonary pressure around zero homogenized VT distribution opening the lungs. PEEP>16 cm H2O equalized distribution of VT but with overdistension for both lungs.
dc.description.abstractConclusions: Despite asymmetrical lung injury, Ppl between injured and noninjured lungs is equalized and esophageal pressure is a reliable estimate of dorsal Ppl. Driving transpulmonary pressure is similar for both lungs. VT distribution results from regional respiratory system compliance. Moderate PEEP homogenizes VT distribution between lungs without generating hyperinflation.
dc.description.funderCanadian Institutes of Health Research
dc.fuente.origenWOS
dc.identifier.doi10.1164/rccm.202005-1556OC
dc.identifier.eissn1535-4970
dc.identifier.issn1073-449X
dc.identifier.urihttps://doi.org/10.1164/rccm.202005-1556OC
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/94738
dc.identifier.wosidWOS:000641150300012
dc.issue.numero8
dc.language.isoen
dc.pagina.final976
dc.pagina.inicio969
dc.revistaAmerican journal of respiratory and critical care medicine
dc.rightsacceso restringido
dc.subjectacute lung injury
dc.subjectesophageal pressure
dc.subjectrespiratory mechanics
dc.subjectmechanical ventilation
dc.subjectmonitoring
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleRole of Positive End-Expiratory Pressure and Regional Transpulmonary Pressure in Asymmetrical Lung Injury
dc.typeartículo
dc.volumen203
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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