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Editorial
. 2021 Apr 15;203(8):934-937.
doi: 10.1164/rccm.202011-4116ED.

Transpulmonary Pressure-guided Ventilation to Attenuate Atelectrauma and Hyperinflation in Acute Lung Injury

Purnema Madahar  1   2 , Daniel Talmor  3 , Jeremy R Beitler  1   2
Affiliations
Editorial

Transpulmonary Pressure-guided Ventilation to Attenuate Atelectrauma and Hyperinflation in Acute Lung Injury

Purnema Madahar et al. Am J Respir Crit Care Med. .
No abstract available

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Figures

Figure 1.
Figure 1.
Transpulmonary pressure (Pl) to guide lung-protective ventilation. (A) Theoretical relationship of Pl with the competing risks of ventilation-induced lung injury (VILI) from overdistension and atelectrauma. The risk of clinically meaningful injury from overdistension exceeds that of atelectrauma. (B) Ventilator titration ideally would seek to attenuate both overdistension and atelectrauma in at-risk patients. Maximal lung protection may occur when positive end-expiratory pressure is set to achieve an end-expiratory Pl near 0 cm H2O and Vt is targeted to a driving Pl of ≤10–12 cm H2O. Boxes reflect the range of Pl during tidal ventilation in a theoretical patient with severe acute respiratory distress syndrome. Red, yellow, and green colored boxes denote high, moderate, and low risk of VILI, respectively. In practice, patient susceptibility to biophysical injury may be a key determinant of the numerical threshold at which the risk of lung injury from overdistension exceeds that of atelectrauma. For reference, in the lean, healthy, spontaneously breathing adult, Pl is ∼0 cm H2O at FRC, 10 cm H2O at end-inspiration during normal tidal breathing, and 20–25 cm H2O at TLC. Reported Vt is in ml/kg predicted body weight, and ∆P is in cm H2O. *If gas exchange permits; †if Vt cannot be lowered. ∆P = driving pressure; End-Insp. = end-inspiration.
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References

    1. Muscedere JG, Mullen JB, Gan K, Slutsky AS. Tidal ventilation at low airway pressures can augment lung injury. Am J Respir Crit Care Med. 1994;149:1327–1334. - PubMed
    1. Ghadiali SN, Gaver DP. Biomechanics of liquid-epithelium interactions in pulmonary airways. Respir Physiol Neurobiol. 2008;163:232–243. - PMC - PubMed
    1. Fumagalli J, Berra L, Zhang C, Pirrone M, Santiago RRS, Gomes S, et al. Transpulmonary pressure describes lung morphology during decremental positive end-expiratory pressure trials in obesity. Crit Care Med. 2017;45:1374–1381. - PubMed
    1. Loring SH, Pecchiari M, Della Valle P, Monaco A, Gentile G, D’Angelo E. Maintaining end-expiratory transpulmonary pressure prevents worsening of ventilator-induced lung injury caused by chest wall constriction in surfactant-depleted rats. Crit Care Med. 2010;38:2358–2364. - PMC - PubMed
    1. Bastia L, Engelberts D, Osada K, Katira BH, Damiani LF, Yoshida T, et al. Role of positive end-expiratory pressure and regional transpulmonary pressure in asymmetrical lung injury. Am J Respir Crit Care Med. 2021;203:969–976. - PubMed