How to measure respiratory mechanics during controlled mechanical ventilation
Measurement of respiratory mechanics
Bedside measurement of respiratory mechanics allows to closely monitor the lung function in critically ill patients. The two fundamental parameters describing the respiratory system mechanics are resistance and compliance. Resistance of the respiratory system describes the opposition to gas flow during inspiration. During volume-controlled ventilation, resistance can be calculated as the ratio between the peak to plateau pressure drop and the resulting flow rate. Compliance describes the elastic property of the respiratory system, comprising the lung and the chest wall. It is the ratio between a change in volume (i.e. tidal volume) and the corresponding change in pressure, calculated as the difference between plateau pressure and total positive end-expiratory pressure, measured by end-inspiratory and end-expiratory manual occlusion, respectively. In this review, we describe how to measure respiratory mechanics at the bedside, starting from the physiological background of the equation of motion of the respiratory system. (Intensive care)
Hess DR, Medoff BD, Fessler MB. Pulmonary mechanics and graphics during positive pressure ventilation. Int Anesthesiol Clin. 1999;37(3):15-34.
Lucangelo U, Bernabé F, Blanch L. Lung mechanics at the bedside: make it simple. Curr Opin Crit Care. 2007;13(1):64-72.
Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369:2126-2136.
Uhlig S, Ranieri M, Slutsky AS. Biotrauma hypothesis of ventilator-induced lung injury. Am J Respir Crit Care Med. 2004; 169:314-315.
Rubini A. Flow and volume dependence of resistive pressures dissipation in the respiratory system. Minerva Pneum. 2017; 56(4):249-253.
Marini JJ. Dynamic hyperinflation and auto-positive endexpiratory pressure: lessons learned over 30 years. Am J Respir Crit Care Med. 2011;184(7):756-762.
Blanch L, Bernabé F, Lucangelo U. Measurement of air trapping, intrinsic positive end-expiratory pressure, and dynamic hyperinflation in mechanically ventilated patients. Respir Care. 2005;50(1):110-123.
MacIntyre NR. Evidence-based guidelines for weaning and discontinuing ventilatory support. Chest. 2001;120:375S-396S.
Grieco DL, Russo A, Antonelli M. Lung volumes, respiratory mechanics and dynamic strain during general anaesthesia. Br J Anaesth. 2018 Nov 1;121(5):1156-1165.
Gattinoni L, Marini JJ, Brochard L. The “baby lung” became an adult. Intensive Care Med. 2016;42:663-673.
Chen L, Del Sorbo L, Brochard L. Airway closure in acute respiratory distress syndrome: an underestimated and
misinterpreted phenomenon. Am J Respir Crit Care Med. 2017 May 30;197(1):132-136.
Sosio S, Bellani G. Plateau Pressure during Pressure Control Ventilation. Abtpn [Internet]. 2019 Oct 22;6(1):76-77.
Copyright (c) 2019 The authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors contributing to AboutOpen agree to publish their articles under the CC Attribution-NonCommercial-NoDerivatives 4.0 license, which allows third parties to copy and redistribute the material providing appropriate credit and a link to the license but does not allow to use the material for commercial purposes and to use the material if it has been remixed, transformed or built upon.