Driving Pressure and Transpulmonary Pressure

Effect of different pressure-targeted modes of ventilation on transpulmonary pressure and inspiratory effort

Introduction Spontaneous breathing during mechanical ventilation improves gas exchange and might prevent ventilatorinduced diaphragm dysfunction. In pressure-targeted modes, transpulmonary pressure (PL) is the sum of pressure generated by the ventilator and muscular pressure. When inspiratory effort increases, PL and tidal volume (VT) increase, potentially resulting in lung injury. This effect ...

A critical appraisal of transpulmonary and diastolic pressure gradients

Pulmonary hypertension (PH) resulting from left heart failure is an increasingly recognized clinical entity. To distinguish isolated postcapillary PH from combined post- and precapillary PH, the use of a diastolic pressure gradient (DPG = diastolic Pulmonary Artery Pressure - Pulmonary Arterial Wedge Pressure, dPAP - PAWP) has been advocated over the transpulmonary pressure gradient (TPG = mean...

Targeting transpulmonary pressure to prevent ventilator induced lung injury.

Acute respiratory distress syndrome (ARDS) and ventilator induced lung injury (VILI) continue to challenge clinicians who care for the critically ill. Current research in ARDS has focused on ventilator strategies to improve the outcome for these patients. In this review, we emphasize the limitations of managing ventilators based on airway pressures alone. Specifically, basic pulmonary mechanics...

Transpulmonary pressure: a more pathophysiological open lung approach?*.

Impact of large volume paracentesis on respiratory parameters including transpulmonary pressure and on transpulmonary thermodilution derived hemodynamics: A prospective study

INTRODUCTION Appropriate mechanical ventilation and prevention of alveolar collaps is mainly dependent on transpulmonary pressure TPP. TPP is assessed by measurement of esophageal pressure EP, largely influenced by pleural and intraabdominal pressure IAP. Consecutively, TPP-guided ventilation might be particularly useful in patients with high IAP. This study investigates the impact of large vol...