Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 23.
doi: 10.1164/rccm.202411-2155OC. Online ahead of print.

Physiological Consequences of Breathing Effort According to the Mode of Ventilation During Acute Hypoxemic Respiratory Failure

Irene Telias  1 , Matías Madorno  2   3 , Tài Pham  4 , Rémi Coudroy  5 , Ricard Mellado Artigas  6 , Elias Baedorf-Kassis  7 , Chang-Wen Chen  8 , Savino Spadaro  9 , Davide Chiumello  10 , Jeremy Beitler  11   12 , Eumorfia Kondili  13   14 , Norberto Tiribelli  15 , Sebastian Fredes  15   16 , Tobias Becher  17 , Martin Dres  18 , Kuan Liu  19 , Nicolas Terzi  20 , Claude Guérin  21 , Tommaso Mauri  22 , Oriol Roca  23 , Jordi Mancebo  24 , Nuria Rodriguez  24 , Jean-Michel Arnal  25 , Ewan C Goligher  26 , Jean-Luc Diehl  27 , Sébastien Jochmans  28   29 , François Beloncle  30 , Nuttapol Rittayamai  31 , Francesco Mojoli  32 , Leo Heunks  33 , Heder de Vries  34   35 , Jian-Xin Zhou  36 , Christophe Guervilly  37   38 , Laurent Brochard  39   40
Affiliations

Physiological Consequences of Breathing Effort According to the Mode of Ventilation During Acute Hypoxemic Respiratory Failure

Irene Telias et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Excessive stress (distending pressure), strain (volume deformation), and drop in inspiratory alveolar pressure are proposed mechanisms for patient self-inflicted lung injury.

Objectives: To dissect the influence of inspiratory effort, respiratory mechanics, and ventilation mode on lung stress, strain, and drop in inspiratory alveolar pressure; and explore their impact on oxygenation and lung compliance.

Methods: International cohort study analyzing respiratory recordings (esophageal pressure) of patients with acute hypoxemic respiratory failure. Association between muscular pressure (Pmus), surrogates of stress (driving trans-alveolar pressure), strain (tidal volume), and inspiratory alveolar pressure relative to PEEP were explored with mixed-models, including interactions for ventilation mode, respiratory system elastance, and synchrony. Association between these and changes in oxygenation and lung compliance were explored.

Measurements and main results: 60 patients from 15 centers represented 528 recordings (339,796 breaths). For each cmH2O Pmus increase there was an increase in driving trans-alveolar pressure (median[CI 95%] 0.28[0.27-0.29]cmH2O) and tidal volume (0.16[0.16-0.17]ml/kg of predicted body weight) and decrease in alveolar pressure (-0.25[0.24-0.6]cmH2O, p<0.001). Volume-control ventilation showed less increase in stress and strain surrogates than pressure-targeted modes, but more drop in alveolar pressure (p<0.001, Pmus:mode interaction). Breath-stacking was infrequent and associated with higher stress. Lower inspiratory alveolar pressure relative to PEEP was associated with subsequent worsening oxygenation (p=0.04) and higher stress with worsening lung compliance (p=0.023).

Conclusion: Strong efforts are associated with high surrogates for lung stress, strain, and lower inspiratory alveolar pressure relative to PEEP, differently according to the mode of ventilation, being associated with subsequent worsening oxygenation and lung compliance.

Keywords: acute hypoxemic respiratory failure; breathing effort; mechanical ventilation; mode of ventilation; patient self-inflicted lung injury.

PubMed Disclaimer

LinkOut - more resources