P Pelosi, M Cereda, G Foti, M Giacomini and A Pesenti
Istituto di Anestesia e Rianimazione, Universita di Milano, Italy.

In 16 mechanically ventilated patients with acute lung injury (ALI) (eight patients with moderate ALI [moderate group], eight patients with severe ALI [adult respiratory distress syndrome, ARDS group]) and in eight normal anesthetized-paralyzed subjects (control group), we partitioned the total respiratory system mechanics into the lung (L) and chest wall (w) mechanics using the esophageal balloon technique together with the airway occlusion technique during constant flow inflation. We measured lung elastance (Est,L), chest wall elastance (Est,w), and total lung (Rmax, L) and chest wall (Rmax,w) resistance. Rmax,L includes airway (Rmin,L) and "additional" lung resistance (DR,L). DR,L represents the "additional" component due to the viscoelastic phenomena of the lung tissues and time-constant inequalities (pendelluft). Measurements were repeated at 0, 5, and 10 cm H2O of positive end-expiratory pressure (PEEP) in the control group and at 0, 5, 10, and 15 cm H2O PEEP in patients with ALI. The end- expiratory lung volume (EELV) was measured at each level of PEEP. Specific total lung (sRmax,L), airway (sRmin,L), and "additional" lung (sDR,L) resistances were obtained as Rmax,L x EELV, Rmin,L x EELV, and DR,L x EELV, respectively. At PEEP 0 cm H2O, we found that both Est,L (23.7 +/- 5.5 and 13.8 +/- 3.3 versus 9.3 +/- 1.7 cm H2O/L; p < 0.01) and Est,w (13.2 +/- 5.4 and 9.9 +/- 2.1 versus 5.6 +/- 2.3 cm H2O/L; p < 0.01) were markedly increased in patients with ARDS and moderate ALI compared with control subjects, with a significant (p < 0.01) effect of the severity of the disease on Est,L (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				S. H. Loring, C. R. O'Donnell, N. Behazin, A. Malhotra, T. Sarge, R. Ritz, V. Novack, and D. Talmor Esophageal pressures in acute lung injury: do they represent artifact or useful information about transpulmonary pressure, chest wall mechanics, and lung stress? J Appl Physiol, March 1, 2010; 108(3): 515 - 522. [Abstract] [Full Text] [PDF]

				D. Chiumello, E. Carlesso, P. Cadringher, P. Caironi, F. Valenza, F. Polli, F. Tallarini, P. Cozzi, M. Cressoni, A. Colombo, et al. Lung Stress and Strain during Mechanical Ventilation for Acute Respiratory Distress Syndrome Am. J. Respir. Crit. Care Med., August 15, 2008; 178(4): 346 - 355. [Abstract] [Full Text] [PDF]

				F. J. Jacono, Y.-J. Peng, D. Nethery, J. A. Faress, Z. Lee, J. A. Kern, and N. R. Prabhakar Acute lung injury augments hypoxic ventilatory response in the absence of systemic hypoxemia J Appl Physiol, December 1, 2006; 101(6): 1795 - 1802. [Abstract] [Full Text] [PDF]

				F. Petak, W. Habre, B. Babik, J. Tolnai, and Z. Hantos Crackle-sound recording to monitor airway closure and recruitment in ventilated pigs. Eur. Respir. J., April 1, 2006; 27(4): 808 - 816. [Abstract] [Full Text] [PDF]

				C. Olegard, S. Sondergaard, E. Houltz, S. Lundin, and O. Stenqvist Estimation of Functional Residual Capacity at the Bedside Using Standard Monitoring Equipment: A Modified Nitrogen Washout/Washin Technique Requiring a Small Change of the Inspired Oxygen Fraction Anesth. Analg., July 1, 2005; 101(1): 206 - 212. [Abstract] [Full Text] [PDF]

				R. L. Dellaca, L. D. Black, H. Atileh, A. Pedotti, and K. R. Lutchen Effects of posture and bronchoconstriction on low-frequency input and transfer impedances in humans J Appl Physiol, July 1, 2004; 97(1): 109 - 118. [Abstract] [Full Text] [PDF]

				J. A. Victorino, J. B. Borges, V. N. Okamoto, G. F. J. Matos, M. R. Tucci, M. P. R. Caramez, H. Tanaka, F. S. Sipmann, D. C. B. Santos, C. S. V. Barbas, et al. Imbalances in Regional Lung Ventilation: A Validation Study on Electrical Impedance Tomography Am. J. Respir. Crit. Care Med., April 1, 2004; 169(7): 791 - 800. [Abstract] [Full Text] [PDF]

				M. Quintel, P. Pelosi, P. Caironi, J. P. Meinhardt, T. Luecke, P. Herrmann, P. Taccone, C. Rylander, F. Valenza, E. Carlesso, et al. An Increase of Abdominal Pressure Increases Pulmonary Edema in Oleic Acid-induced Lung Injury Am. J. Respir. Crit. Care Med., February 15, 2004; 169(4): 534 - 541. [Abstract] [Full Text] [PDF]

				L. Gattinoni, E. Carlesso, P. Cadringher, F. Valenza, F. Vagginelli, and D. Chiumello Physical and biological triggers of ventilator-induced lung injury and its prevention Eur. Respir. J., November 16, 2003; 22(47_suppl): 15s - 25s. [Abstract] [Full Text] [PDF]

				C. Pereira, J. Bohe, S. Rosselli, E. Combourieu, C. Pommier, J.-P. Perdrix, J.-C. Richard, M. Badet, S. Gaillard, F. Philit, et al. Sigmoidal equation for lung and chest wall volume-pressure curves in acute respiratory failure J Appl Physiol, November 1, 2003; 95(5): 2064 - 2071. [Abstract] [Full Text] [PDF]

				S.M. Maggiore, J-C. Richard, and L. Brochard What has been learnt from P/V curves in patients with acute lung injury/acute respiratory distress syndrome Eur. Respir. J., August 1, 2003; 22(42_suppl): 22s - 26s. [Abstract] [Full Text] [PDF]

				J. A. Coss-Bu, D. L. Walding, Y. B. David, and L. S. Jefferson Dead Space Ventilation in Critically Ill Children With Lung Injury Chest, June 1, 2003; 123(6): 2050 - 2056. [Abstract] [Full Text] [PDF]

				B. Babik, F. Petak, T. Asztalos, Z.I. Deak, G. Bogats, and Z. Hantos Components of respiratory resistance monitored in mechanically ventilated patients Eur. Respir. J., December 1, 2002; 20(6): 1538 - 1544. [Abstract] [Full Text] [PDF]

				ATS/ERS Statement on Respiratory Muscle Testing Am. J. Respir. Crit. Care Med., August 15, 2002; 166(4): 518 - 624. [Full Text] [PDF]

				M S Smyth and J H Martin Picornavirus uncoating Mol. Pathol., August 1, 2002; 55(4): 214 - 219. [Abstract] [Full Text] [PDF]

				K. Gerber, E. Wimmer, and A. V. Paul Biochemical and Genetic Studies of the Initiation of Human Rhinovirus 2 RNA Replication: Identification of a cis-Replicating Element in the Coding Sequence of 2Apro J. Virol., November 15, 2001; 75(22): 10979 - 10990. [Abstract] [Full Text] [PDF]

				S. M. MAGGIORE, B. JONSON, J.-C. RICHARD, S. JABER, F. LEMAIRE, and L. BROCHARD Alveolar Derecruitment at Decremental Positive End-Expiratory Pressure Levels in Acute Lung Injury . Comparison with the Lower Inflection Point, Oxygenation, and Compliance Am. J. Respir. Crit. Care Med., September 1, 2001; 164(5): 795 - 801. [Abstract] [Full Text] [PDF]

				G. Mols, V. Kessler, A. Benzing, M. Lichtwarck-Aschoff, K. Geiger, and J. Guttmann Is pulmonary resistance constant, within the range of tidal volume ventilation, in patients with ARDS? Br. J. Anaesth., February 1, 2001; 86(2): 176 - 182. [Abstract] [Full Text] [PDF]

				A. ALIVERTI, R. DELLACA, P. PELOSI, D. CHIUMELLO, A. PEDOTTI, and L. GATTINONI Optoelectronic Plethysmography in Intensive Care Patients Am. J. Respir. Crit. Care Med., May 1, 2000; 161(5): 1546 - 1552. [Abstract] [Full Text]

				A. KOUTSOUKOU, A. ARMAGANIDIS, C. STAVRAKAKI-KALLERGI, T. VASSILAKOPOULOS, A. LYMBERIS, C. ROUSSOS, and J. MILIC-EMILI Expiratory Flow Limitation and Intrinsic Positive End-Expiratory Pressure at Zero Positive End-Expiratory Pressure in Patients with Adult Respiratory Distress Syndrome Am. J. Respir. Crit. Care Med., May 1, 2000; 161(5): 1590 - 1596. [Abstract] [Full Text]

				M. F. CEREDA, M.-E. SPARACINO, A. R. FRANK, R. TRAWOGER, and T. KOLOBOW Efficacy of Tracheal Gas Insufflation in Spontaneously Breathing Sheep with Lung Injury Am. J. Respir. Crit. Care Med., March 1, 1999; 159(3): 845 - 850. [Abstract] [Full Text]

				L. GATTINONI, P. PELOSI, P. M. SUTER, A. PEDOTO, P. VERCESI, and A. LISSONI Acute Respiratory Distress Syndrome Caused by Pulmonary and Extrapulmonary Disease . Different Syndromes? Am. J. Respir. Crit. Care Med., July 1, 1998; 158(1): 3 - 11. [Abstract] [Full Text] [PDF]

				S. Uhlig, R. L. Featherstone, H.-D. Held, R. Nusing, C. Schudt, and A. Wendel Attenuation by Phosphodiesterase Inhibitors of Lipopolysaccharide-Induced Thromboxane Release and Bronchoconstriction in Rat Lungs J. Pharmacol. Exp. Ther., December 1, 1997; 283(3): 1453 - 1459. [Abstract] [Full Text]

				V. M. RANIERI, N. BRIENZA, S. SANTOSTASI, F. PUNTILLO, L. MASCIA, N. VITALE, R. GIULIANI, V. MEMEO, F. BRUNO, T. FIORE, et al. Impairment of Lung and Chest Wall Mechanics in Patients with Acute Respiratory Distress Syndrome . Role of Abdominal Distension Am. J. Respir. Crit. Care Med., October 1, 1997; 156(4): 1082 - 1091. [Abstract] [Full Text] [PDF]

				G. FOTI, M. CEREDA, G. BANFI, P. PELOSI, R. FUMAGALLI, and A. PESENTI End-Inspiratory Airway Occlusion . A Method To Assess the Pressure Developed by Inspiratory Muscles in Patients with Acute Lung Injury Undergoing Pressure Support Am. J. Respir. Crit. Care Med., October 1, 1997; 156(4): 1210 - 1216. [Abstract] [Full Text] [PDF]

				M. MERGONI, A. MARTELLI, A. VOLPI, S. PRIMAVERA, P. ZUCCOLI, and A. ROSSI Impact of Positive End-expiratory Pressure on Chest Wall and Lung Pressure-Volume Curve in Acute Respiratory Failure Am. J. Respir. Crit. Care Med., September 1, 1997; 156(3): 846 - 854. [Abstract] [Full Text] [PDF]

				P. PELOSI, D. TUBIOLO, D. MASCHERONI, P. VICARDI, S. CROTTI, F. VALENZA, and L. GATTINONI Effects of the Prone Position on Respiratory Mechanics and Gas Exchange during Acute Lung Injury Am. J. Respir. Crit. Care Med., February 1, 1997; 157(2): 387 - 393. [Abstract] [Full Text]