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Chest wall loading in the ICU: pushes, weights, and positions
John Selickman1,2, John J Marini3,4
1Department of Pulmonary and Critical Care Medicine, University of Minnesota, Minneapolis, MN, USA. selic002@umn.edu.
Annals of Intensive Care
|November 8, 2022
Summary
Applying external pressure to the chest wall can reveal hidden lung hyperinflation in patients on mechanical ventilation. This technique helps improve lung compliance and assess respiratory mechanics.
Area of Science:
- Respiratory Physiology
- Critical Care Medicine
- Pulmonary Mechanics
Background:
- Mechanical ventilation relies on airway pressures (plateau, driving) to ensure safe tidal volumes.
- Respiratory system mechanics, including lung and chest wall properties, influence these pressures.
- External chest wall compression is an underutilized intervention in intensive care units.
Purpose of the Study:
- To explore the diagnostic and therapeutic potential of chest wall modification.
- To highlight the role of lung and chest wall interactions in respiratory mechanics.
- To demonstrate the utility of chest wall modification in detecting end-tidal hyperinflation.
Main Methods:
- Review of recent literature on respiratory mechanics in ARDS patients.
- Analysis of physiological principles governing lung and chest wall interactions.
- Application of these principles to clinical observations of chest wall modification.
Main Results:
- Interventions reducing resting lung volume (e.g., chest wall loading, prone positioning) can improve lung and respiratory system compliance.
- These improvements are linked to the reduction of previously undetected end-tidal hyperinflation.
- Chest wall modification offers a method for detecting end-tidal hyperinflation.
Conclusions:
- Understanding lung and chest wall interactions is crucial for managing mechanically ventilated patients.
- Chest wall modification is a valuable tool for diagnosing end-tidal hyperinflation.
- This counterintuitive practice holds diagnostic and potential therapeutic benefits in critical care.
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