Paradoxical Respiration and “Pendelluft”

Maloney, James V.; Schmutzer, Karl J.; Raschke, E

doi:10.1016/s0022-5223(20)31689-5

Cited by 76 publications

(5 citation statements)

References 4 publications

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“…Since pendelluft could be potentially harmful by introducing local overstretch, tidal recruitment and inflammation (4), the detection of pendelluft is warranted so that the treatment or ventilation strategies could be adjusted accordingly. In early days with limited technology options, pendelluft was observed in surgeries with an open hemithorax (5). The ventilation asynchrony could only be detected between left to right lungs in experimental settings (6).…”

Section: Introductionmentioning

confidence: 99%

Qualitative and quantitative assessment of pendelluft: a simple method based on electrical impedance tomography

et al. 2020

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Background: Pendelluft, defined as asynchronous alveolar ventilation, is caused by different regional time constants or dynamic pleural pressure variations. The aim of the present study was to propose a simple method to evaluate pendelluft based on electrical impedance tomography (EIT). The efficacy of this method was demonstrated in well-known pendelluft scenarios in 6 patients.Methods: Two patients with flail chest after accidents, two patients with acute respiratory distress syndrome (ARDS) and two patients with acutely exacerbated obstructive lung disease were prospectively included. EIT measurements were performed before and after surgery (in patients with flail chest, who had video-assisted thoracoscopic surgery with ribs fixation), or at two different levels of positive end-expiratory pressure (PEEP; ARDS patients), or two different time points (obstructive lung disease). Pendelluft was assessed by regional phase shift (defined as time difference between global and regional impedance-time curves) and amplitude differences (defined as the impedance difference between sum of all regional tidal variation and the global tidal variation).Results: In patients with flail chest, pendelluft diminished several days after surgery (pendelluft amplitude normalized to tidal impedance variation reduced from 88% to 2% in one patient, 12% to 2% in the other).Increased PEEP reduced the amplitude of pendelluft (from 3% to 0% in one patient, 20% to 2% in the other) but not necessarily the phase shifts (average time differences were <0.1 second for both patients for both ins-and expiration) in ARDS patients.

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Section: Introductionmentioning

confidence: 99%

Qualitative and quantitative assessment of pendelluft: a simple method based on electrical impedance tomography

et al. 2020

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“…When this occurs, the accessory muscles contract by raising the ribs and briefly expanding the chest. Even before expansion occurs, the anatomical structures offering low resistance are concentrated concentrically (intercostal and abdominal region), exhibiting a depression of the skin that can be seen with the naked eye 34 .…”

Section: Discussionmentioning

confidence: 99%

Automated didactic prototype of pulmonary ventilation exhibits a simulation of intrathoracic pressure variations during diaphragmatic function

Pereira

Lopes

Hohl

et al. 2022

Rev. Med. (São Paulo)

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The movement of air from the environment to the alveoli is a vital and complex phenomenon that occurs due to variations in intrathoracic and airway pressures in relation to the atmosphere. The construction of didactic prototypes can minimize the abstraction required in these in vivo phenomena. In this study, we automated a didactic prototype of pulmonary ventilation already described in literature to simulate and exhibit variations in intrathoracic pressure during diaphragmatic function. A pulmonary ventilation (PV) prototype was produced with recyclable materials, and automated by adapting a pressure sensor in the system to generate pressure curves as a function of time during the simulation of diaphragmatic function. The automated plunger’s downward traction induced by the servomotor (such as diaphragmatic) reduced the pressure inside the bottle (intrathoracic), and this variation can be observed graphically on a computer interface while the balloon was expanded, and atmospheric air invaded its interior. Conclusion: The incorporation of technology into a simple PV prototype allowed a safe and simulated demonstration of how the diaphragm induces the variation of the intrathoracic pressure in relation to the atmosphere concomitantly with the pulmonary deformation that occurs during inspiration and exhalation.

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“…It was previously thought that this caused impaired ventilation by a phenomenon called pendelluftthe to-and-fro motion of air from the uninvolved to the involved lung. 41 More recent data, however, suggest that ipsilateral ventilation is not impaired, and that the respiratory complications of flail chest, including pneumonia, result from pain at the fracture sites causing splinting and decreased FRC combined with the underlying pulmonary contusion. 42 Pulmonary complications are particularly prevalent in patients with burn injuries.…”

Section: Early Pneumoniamentioning

confidence: 99%

Hospital-Acquired Pneumonia in the Postoperative Setting

Yaffe¹,

Fink²

1997

Semin Respir Crit Care Med

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Hospital-acquired pneumonia in the postoperative or trauma patient is a common and troublesome complication. A variety of patient factors such as smoking, chronic obstructive pulmonary disease (COPD), morbid obesity, and poor overall medical condition, along with therapeutic interventions such as abdominal and thoracic operations, the need for prolonged intubation and mechanical ventilation, and postoperative changes in respiratory mechanics increase the risk for nosocomial pneumonia in surgical patients. Establishing the diagnosis of hospital-acquired pneumonia in this group of patients is notoriously difficult, since systemic signs of inflammation and radiographic changes of atelectasis or chest trauma that mimic infectious infiltrates are common. Early-onset and late-onset pneumonia in these patients have different associated risk factors, microbiology, and prognosis. Late-onset pneumonia in both postoperative and trauma patients is associated with significant mortality. A variety of preventive measures such as selective digestive decontamination, continuous postural oscillation, and preoperative respiratory muscle training may be beneficial in selected circumstances.

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Paradoxical Respiration and “Pendelluft”

Cited by 76 publications

References 4 publications

Qualitative and quantitative assessment of pendelluft: a simple method based on electrical impedance tomography

Qualitative and quantitative assessment of pendelluft: a simple method based on electrical impedance tomography

Automated didactic prototype of pulmonary ventilation exhibits a simulation of intrathoracic pressure variations during diaphragmatic function

Hospital-Acquired Pneumonia in the Postoperative Setting

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