Two steps forward in bedside monitoring of lung mechanics: transpulmonary pressure and lung volume

Excerpt

For many decades, pressure-based respiratory mechanics have served to aid the judgment of clinicians when monitoring mechanical ventilation and making important decisions in respiratory care. However, measurements based on airway pressure (P_AW) alone have limited ability to generate individualized insights for a diverse patient population with varied pathologic conditions. While the passive lungs are the primary target of attention, P_AW-based interpretations may be influenced by differences in breathing pattern, alterations in chest wall activity (including diaphragmatic function), changes in lung volume, asymmetry of lung disease, abdominal distension, etc. All of these factors may complicate the interpretation of respiratory mechanics and make fixed criteria for safe ventilation difficult to apply. …