The chest wall in acute lung injury/acute respiratory distress syndrome

Current Opinion in Critical Care
Dean R Hess, Luca M Bigatello

Abstract

There has recently been renewed interest in the chest wall during mechanical ventilation, related to lung-protective ventilation strategies, as well as in the role of abdominal pressure in many facets of critical illness. The purpose of this review is to address relevant issues related to the chest wall and mechanical ventilation, particularly in patients with acute lung injury/acute respiratory distress syndrome. In mechanically ventilated patients with acute lung injury, intra-abdominal pressure is an important determinant of chest wall compliance. With elevated intra-abdominal pressure, the compliance of the chest wall and total respiratory system is decreased, with a relatively normal compliance of the lungs. The lung compression effects of increased intra-abdominal pressure may lead to a loss of lung volume with atelectasis. An appropriate level of positive end-expiratory pressure is necessary to counterbalance this collapsing effect on the lungs. Also, the stiff chest wall results in a lower transpulmonary pressure during positive-pressure ventilation. As chest wall compliance may have important clinical implications during positive-pressure ventilation, the physiology of this effect should be considered, particularly in ...Continue Reading

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Citations

Feb 18, 2011·Current Opinion in Critical Care·Maria Plataki, Rolf D Hubmayr
Feb 11, 2012·Intensive Care Medicine·Salvatore GrassoV Marco Ranieri
Jun 3, 2015·Chest·James Leatherman
May 6, 2010·Chest·Adebayo EsanCurtis N Sessler
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Dec 29, 2009·The Journal of Surgical Research·Brian D KubiakGary F Nieman
Dec 24, 2015·Intensive Care Medicine Experimental·Michaela Kollisch-SinguleNader M Habashi
Sep 28, 2010·Methods of Information in Medicine·F ManciniI T Pisa
Oct 26, 2010·Critical Care Clinics·Doyle D AshburnMary Jane Reed
May 28, 2014·Journal of Critical Care·Paolo FormentiGaetano Iapichino
Dec 3, 2014·Clinics in Chest Medicine·Renee D Stapleton, Benjamin T Suratt
Sep 10, 2013·Best Practice & Research. Clinical Anaesthesiology·Lorenzo BallPaolo Pelosi
Nov 20, 2009·Critical Care Medicine·Martin C J Kneyber, Dick G Markhorst
Jun 9, 2010·Expert Review of Respiratory Medicine·Maria Plataki, Rolf D Hubmayr
Apr 19, 2012·Critical Care Medicine·Ulrich SchmidtDean R Hess
Nov 27, 2018·Technology and Health Care : Official Journal of the European Society for Engineering and Medicine·Bing WangYan-Ni Ran

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