Lung Stress and Strain during Mechanical Ventilation for Acute Respiratory Distress Syndrome

Chiumello, Davide; Carlesso, Eleonora; Cadringher, Paolo; Caironi, Pietro; Valenza, Franco; Polli, Federico; Tallarini, Federica; Cozzi, Paola; Cressoni, Massimo; Colombo, Angelo; Marini, John J.; Gattinoni, Luciano

doi:10.1164/rccm.200710-1589oc

Cited by 674 publications

(619 citation statements)

References 40 publications

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“…In the study of Chiumello et al 10,. it was shown that stress values, based on esophagus pressure measurements, were 21.8 ± 5.4 and 13.3 ± 3.7 cmH 2 O at respectively 15 and 5 cmH 2 O of PEEP and tidal volume of 10 ml.…”

Section: Discussionmentioning

confidence: 95%

“…In the present study, we found 24.0 ± 2.7 and 13.1 ± 3.8 cmH 2 O in the lung disorder group at the same PEEP and tidal volume. In addition, Chiumello et al 10. showed that for patients with normal lungs, the stress values were 19.2 ± 3.2 and 10.9 ± 3.3 cmH 2 O at respectively 15 and 5 cmH 2 O of PEEP and tidal volume of 8 ml, whereas we found similar values: 21.3 ± 8.1 and 10.6 ± 4.7 cmH 2 O at the same PEEP and tidal volume.…”

Section: Discussionmentioning

confidence: 99%

“…To describe the stress raisers on lung parenchyma, the parameters stress, specific elastance, and strain are introduced (stress = specific elastance x strain). Chiumello et al 10. calculated lung stress and strain in 80 volume‐controlled ventilated patients with and without lung disorders, at four different tidal volumes (6, 8, 10, and 12 ml/kg) and during two different PEEP levels (5 and 15 cmH 2 O).…”

Section: Discussionmentioning

confidence: 99%

“…Otherwise, the analysis was carried out using the independent samples Kruskal–Wallis test. A linear regression model was performed to compare the stress measured by Chiumello et al 10. with our stress calculations (Graphpad Prism version 5.0; Graphpad Software Inc., San Diego, CA, USA).…”

Section: Methodsmentioning

confidence: 99%

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Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit

Blankman

Hasan

Bikker

et al. 2015

Acta Anaesthesiol Scand

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BackgroundStress and strain are parameters to describe respiratory mechanics during mechanical ventilation. Calculations of stress require invasive and difficult to perform esophageal pressure measurements. The hypothesis of the present study was: Can lung stress be reliably calculated based on non‐invasive lung volume measurements, during a decremental Positive end‐expiratory pressure (PEEP) trial in mechanically ventilated patients with different diseases?MethodsData of 26 pressure‐controlled ventilated patients admitted to the ICU with different lung conditions were retrospectively analyzed: 11 coronary artery bypass graft (CABG), 9 neurology, and 6 lung disorders. During a decremental PEEP trial (from 15 to 0 cmH2O in three steps) end‐expiratory lung volume (EELV) measurements were performed at each PEEP step, without interruption of mechanical ventilation. Strain, specific elastance, and stress were calculated for each PEEP level. Elastance was calculated as delta PEEP divided by delta PEEP volume, whereas specific elastance is elastance times the FRC. Stress was calculated as specific elastance times the strain. Global strain was divided into dynamic (tidal volume) and static (PEEP) strain.ResultsStrain calculations based on FRC showed mainly changes in static component, whereas calculations based on EELV showed changes in both the static and dynamic component of strain. Stress calculated from EELV measurements was 24.0 ± 2.7 and 13.1 ± 3.8 cmH2O in the lung disorder group at 15 and 5 cmH2O PEEP. For the normal lungs, the stress values were 19.2 ± 3.2 and 10.9 ± 3.3 cmH2O, respectively. These values are comparable to earlier publications. Specific elastance calculations were comparable in patients with neurologic and lung disorders, and lower in the CABG group due to recruitment in this latter group.ConclusionStress and strain can reliably be calculated at the bedside based on non‐invasive EELV measurements during a decremental PEEP trial in patients with different diseases.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit

Blankman

Hasan

Bikker

et al. 2015

Acta Anaesthesiol Scand

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“…More recently, two different parameters describing the mechanical insult associated with ventilation have been proposed as actual determinants of VILI: lung stress, defined as the pressure developing within the lung fibrous skeleton, which equals the applied transpulmonary pressure [12], and lung strain, defined as the ratio between the lung volume variation (due to both V T and positive end-expiratory pressure, PEEP) and the lung resting volume [13]. In ARDS, we have recently shown that both V T expressed in relation to body weight and the airway pressure applied are ''inadequate surrogates'' for the evaluation of the actual lung stress and strain applied, due to a large variability in lung resting volume (functional residual capacity, FRC) and in chest wall mechanics [14]. Moreover, we have recently reported [15] that different mechanisms, such as the intratidal lung opening and closing, may be responsible for the lung injury associated with ventilation in ALI/ARDS, therefore questioning direct translation to humans of findings obtained from experimental settings regarding the role of an excessive V T and airway pressure.…”

Section: Introductionmentioning

confidence: 99%

Time to generate ventilator-induced lung injury among mammals with healthy lungs: a unifying hypothesis

et al. 2011

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Purpose: To investigate ventilator-induced lung injury (VILI), several experimental models were designed including different mammalian species and ventilator settings, leading to a large variability in the observed time-course and injury severity. We hypothesized that the time-course of VILI may be fully explained from a single perspective when considering the insult actually applied, i.e. lung stress and strain. Methods: Studies in which healthy animals were aggressively ventilated until preterminal VILI were selected via a Medline search. Data on morphometry, ventilator settings, respiratory function and duration of ventilation were derived. For each animal group, lung stress (transpulmonary pressure) and strain (endinspiratory lung inflation/lung resting volume ratio) were estimated. Results: From the Medline search 20 studies including five mammalian species (sheep, pigs, rabbits, rats, mice) were selected. Time to achieve preterminal VILI varied widely (18-2,784 min), did not correlate with either tidal volume (expressed in relation to body weight) or airway pressure applied, but was weakly associated with lung stress (r 2 = 0.25, p = 0.008). In contrast, the duration of mechanical ventilation was closely correlated with both lung strain (r 2 = 0.85, p \ 0.0001) and lung strain weighted for the actual time of application during each breath (r 2 = 0.83, p \ 0.0001), according to exponential decay functions. When it was normalized for the lung strain applied, larger species showed a greater resistance to VILI than smaller species (medians, 25th-75th percentiles: 690, 460-2,001 min vs. 16, 4-59 min, respectively; p \ 0.001). Conclusion: Lung strain may play a critical role as a unifying rule describing the development of VILI among mammals with healthy lungs.

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Prone Positioning in Patients With Moderate and Severe Acute Respiratory Distress Syndrome

Taccone¹,

Pesenti²,

Latini³

et al. 2009

JAMA

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493

383

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Lung Stress and Strain during Mechanical Ventilation for Acute Respiratory Distress Syndrome

Cited by 674 publications

References 40 publications

Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit

Lung stress and strain calculations in mechanically ventilated patients in the intensive care unit

Time to generate ventilator-induced lung injury among mammals with healthy lungs: a unifying hypothesis

Prone Positioning in Patients With Moderate and Severe Acute Respiratory Distress Syndrome

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