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Review
. 2021 Jul 28;25(1):264.
doi: 10.1186/s13054-021-03700-8.

Improving lung compliance by external compression of the chest wall

John J Marini  1 , Luciano Gattinoni  2
Affiliations
Review

Improving lung compliance by external compression of the chest wall

John J Marini et al. Crit Care. .

Abstract

As exemplified by prone positioning, regional variations of lung and chest wall properties provide possibilities for modifying transpulmonary pressures and suggest that clinical interventions related to the judicious application of external pressure may yield benefit. Recent observations made in late-phase patients with severe ARDS caused by COVID-19 (C-ARDS) have revealed unexpected mechanical responses to local chest wall compressions over the sternum and abdomen in the supine position that challenge the clinician's assumptions and conventional bedside approaches to lung protection. These findings appear to open avenues for mechanism-defining research investigation with possible therapeutic implications for all forms and stages of ARDS.

Keywords: ARDS; Abdominal pressure; COVID-19; Chest wall; External pressure; Mechanical ventilation; Prone position; Respiratory mechanics.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Local modification of chest wall compliance by placing weight over sternum or by sustained pressure applied to mid-upper abdomen (‘belly push’)
Fig. 2
Fig. 2
Schematic illustration of the effect of locally increasing external pressure on the monitored airway pressure waveform by ‘belly push’ or by sternal weighting during passive volume targeted ventilation with constant flow. When steady pressure is applied (downward block arrow) the plateau pressure falls from 40 to 28 cmH2O. These changes are reversed when the external pressure is relieved (upward block arrow). Note that as indicated by the double arrows, the peak pressure may not change as much as the plateau pressure if airway resistance is increased by compression during loading
Fig. 3
Fig. 3
Hypothetical effects of external loading on the compliance characteristics of the lung and chest wall for an unchanging tidal volume. External loading improves the tidal compliance of the lung with severe ARDS by causing leftward migration of tidal transpulmonary tidal pressures. (Dots depict the end-expiratory and end-inspiratory positions prior to loading, and triangles their positions with external load in place.) Normal chest wall and lung pressure volume curves are provided for reference
See this image and copyright information in PMC

Comment in

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