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Transpulmonary pressure: importance and limits.

Domenico Luca Grieco1,2,3, Lu Chen1,2, Laurent Brochard1,2

  • 1Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.

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|August 23, 2017
PubMed
Summary
This summary is machine-generated.

Transpulmonary pressure (PL) helps assess mechanical ventilation in ARDS patients. Monitoring PL can guide ventilator settings to reduce lung injury and improve outcomes.

Keywords:
Acute respiratory distress syndrome (ARDS)driving pressureesophageal pressure (PES)mechanical ventilationrespiratory mechanicsventilator-induced lung injury (VILI)

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Area of Science:

  • Respiratory Physiology
  • Critical Care Medicine
  • Pulmonary Mechanics

Background:

  • Transpulmonary pressure (PL) is crucial for understanding mechanical ventilation effects in Acute Respiratory Distress Syndrome (ARDS).
  • Directly measuring PL involves airway and pleural pressures, with esophageal pressure (PES) as a surrogate for pleural pressure.
  • Understanding pressure gradients is key to optimizing ventilation strategies.

Purpose of the Study:

  • To discuss the role of transpulmonary pressure (PL) in managing mechanical ventilation for ARDS patients.
  • To explore methods for measuring and estimating PL, including its clinical implications.
  • To highlight the importance of limiting end-inspiratory PL to prevent ventilator-induced lung injury (VILI).

Main Methods:

  • Discussion of direct measurement of PL using airway and esophageal pressures (PES).
  • Exploration of the elastance-derived method for estimating PL from plateau airway pressure and respiratory system elastance.
  • Review of clinical data and physiological principles related to PL assessment.

Main Results:

  • Positive end-expiratory PL improves oxygenation and compliance.
  • Elastance-derived PL may better estimate pressure in non-dependent lung zones, indicating lung stress.
  • Limiting end-inspiratory PL to 20-25 cmH2O is suggested to mitigate VILI.

Conclusions:

  • Assessment of transpulmonary pressure (PL), despite limitations, enhances understanding of VILI risk in ARDS.
  • PL monitoring can potentially guide personalized ventilator settings.
  • Lung driving pressure (ΔPL) reflects tidal distending pressure and should be considered during assisted breathing.