The Effect of Compartmental Asymmetry on the Monitoring of Pulmonary Mechanics and Lung Volumes

Abstract

P tracks with aerated lung volume in the setting of thoracic asymmetry and changes in intra-abdominal pressure. However, used alone, it cannot distinguish the relative contributions of air-space distention and recruitment of lung units.

Integration of Pulmonary Mechanics in a Personalized Approach to Mechanical Ventilation

“…9,10 Many other factors may also influence clinical decisions at the bedside, for example, body positioning affects the configuration and dynamic properties of the chest wall, and, therefore, may influence decisions made to increase or decrease ventilating pressures and V T based on parameter such as the stress index, airway driving pressure, or transpulmonary driving pressure. 15,16 Moreover, the vascular side has been de-emphasized as a potential contributor to VILI, despite revealing experimental data that demonstrate that raising precapillary vascular pressure intensifies VILI, 17 and that large vascular pressure gradients promote West zone 2 conditions in which microvas-cular waterfalls (vascular pressure gradients) predispose the vascular endothelium to be injured by poorly tolerated shear stress and applied energy, 17,18, all factors well beyond the evaluative scope of the stress index.…”