Pleural pressure distribution and its relationship to lung volume and interstitial pressure

Lai-Fook, S. J.; Rodarte, Joseph R.

doi:10.1152/jappl.1991.70.3.967

Cited by 125 publications

(117 citation statements)

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“…Two views, in part compatible, exist on the nature of the mechanisms providing the mechanical coupling between the lung and chest wall. They have been extensively described and reviewed elsewhere [1][2][3][4][5][6][7][8][9][10][11]. …”

mentioning

confidence: 99%

Physiology and pathophysiology of pleural fluid turnover

Zocchi¹

2002

Eur Respir J

174

102

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Tight control of the volume and composition of the pleural liquid is necessary to ensure an efficient mechanical coupling between lung and chest wall. Liquid enters the pleural space through the parietal pleura down a net filtering pressure gradient. Liquid removal is provided by an absorptive pressure gradient through the visceral pleura, by lymphatic drainage through the stomas of the parietal pleura, and by cellular mechanisms. Indeed, contrary to what was believed in the past, pleural mesothelial cells are metabolically active, and possess the cellular features for active transport of solutes, including vesicular transport of protein. Furthermore, the mesothelium was shown, on the basis of recent experimental evidence, both in vivo and in vitro, to be a less permeable barrier than previously believed, being provided with permeability characteristics similar to those of the microvascular endothelium. Direct assessment of the relative contribution of the different mechanisms of pleural fluid removal is difficult, due to the difficulty in measuring the relevant parameters in the appropriate areas, and to the fragility of the mesothelium. The role of the visceral pleura in pleural fluid removal under physiological conditions is supported by a number of findings and considerations.Further evidence indicates that direct lymphatic drainage through the stomas of the parietal pleura is crucial in removing particles and cells, and important in removing protein from the pleural space, but should not be the main effector of fluid removal. Its importance, however, increases markedly in the presence of increased intrapleural liquid loads. Removal of protein and liquid by transcytosis, although likely on the basis of morphological findings and suggested by recent indirect experimental evidence, still needs to be directly proven to occur in the pleura. When pleural liquid volume increases, an imbalance occurs in the forces involved in turnover, which favours fluid removal. In case of a primary abnormality of one ore more of the mechanisms of pleural liquid turnover, a pleural effusion ensues. The factors responsible for pleural effusion may be subdivided into three main categories: those changing transpleural pressure balance, those impairing lymphatic drainage, and those producing increases in mesothelial and capillary endothelial permeability. Except in the first case, pleural fluid protein concentration increases above normal: this feature underlies the classification of pleural effusions into transudative and exudative. Eur Respir J 2002; 20: 1545-1558. The thin layer of liquid present between the pleural surfaces has the important function of providing the mechanical coupling between the chest wall and lung, which ensures instantaneous transmission of perpendicular forces between the two structures, and allows their sliding in response to shearing forces [1,2]. It also provides lubrication of the reciprocal motions of the two structures during breathing. Two views, in part compatible, exist on the nature of t...

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mentioning

confidence: 99%

Physiology and pathophysiology of pleural fluid turnover

Zocchi¹

2002

Eur Respir J

174

102

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“…When compared to costal values, pleural liquid pressure is more subatmospheric over the fissures and, even more so, on the cardiac surface. Pregnancy alters this normal nonuniformity of pleural liquid pressure and may promote the accumulation of pleural fluid [16,17]. Normally, pleural liquid is absorbed into lymphatics.…”

Section: Discussionmentioning

confidence: 99%

Benign postpartum pleural effusion

Gourgoulianis

Karantanas²,

Diminikou³

et al. 1995

Eur Respir J

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The conditions of labour appear to favour the development of pleural effusion. The frequency of postpartum pleural effusion was investigated in this study using thoracic ultrasonography. Thirty one postpartum and 22 healthy nonpregnant women of the same age-group were examined, both supine and seated, via an intercostal approach.Seven of the 31 (23%) postpartum women had pleural effusion within 1-24 h of normal delivery. None of the nonpregnant women had pleural effusion. No correlation was found between postpartum pleural effusion and age, weight-gain during pregnancy, duration of labour, use of intravenous fluid, or oxytocin administration.Pleural effusion seems to be a common finding postpartum, but of no clinical significance.

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“…Other techniques have been proposed in the literature, such as: fluid-filled catheters and probes with pressure sensors in the tip, or the direct recording of the pleural pressure [38,39]. As these catheter types have not yet been clinically validated, their use is less standardized than the air-filled catheters [38].…”

Section: Esophageal Pressure Esophageal Pressure Measurementmentioning

confidence: 99%

“…As these catheter types have not yet been clinically validated, their use is less standardized than the air-filled catheters [38]. Instead, direct recording is risky and inadvisable in clinical practice because it requires a hole through the chest wall down to the pleural space [39].…”

Section: Esophageal Pressure Esophageal Pressure Measurementmentioning

confidence: 99%

Transpulmonary pressure monitoring during mechanical ventilation: a bench-to-bedside review

Mietto

Malbrain

Chiumello³

2015

Anaesthesiol Intensive Ther

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Different ventilation strategies have been suggested in the past in patients with acute respiratory distress syndrome (ARDS). Airway pressure monitoring alone is inadequate to assure optimal ventilatory support in ARDS patients. The assessment of transpulmonary pressure (P TP ) can help clinicians to tailor mechanical ventilation to the individual patient needs. Transpulmonary pressure monitoring, defined as airway pressure (P aw ) minus intrathoracic pressure (ITP), provides essential information about chest wall mechanics and its effects on the respiratory system and lung mechanics. The positioning of an esophageal catheter is required to measure the esophageal pressure (P eso ), which is clinically used as a surrogate for ITP or pleural pressure (P pl ), and calculates the transpulmonary pressure. The benefits of such a ventilation approach are avoiding excessive lung stress and individualizing the positive end-expiratory pressure (PEEP) setting. The aim is to prevent over-distention of alveoli and the cyclic recruitment/derecruitment or shear stress of lung parenchyma, mechanisms associated with ventilator-induced lung injury (VILI). Knowledge of the real lung distending pressure, i.e. the transpulmonary pressure, has shown to be useful in both controlled and assisted mechanical ventilation. In the latter ventilator modes, P eso measurement allows one to assess a patient's respiratory effort, patient-ventilator asynchrony, intrinsic PEEP and the calculation of work of breathing. Conditions that have an impact on P eso, such as abdominal hypertension, will also be discussed briefly.

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Pleural pressure distribution and its relationship to lung volume and interstitial pressure

Cited by 125 publications

References 0 publications

Physiology and pathophysiology of pleural fluid turnover

Physiology and pathophysiology of pleural fluid turnover

Benign postpartum pleural effusion

Transpulmonary pressure monitoring during mechanical ventilation: a bench-to-bedside review

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