Spontaneous Breathing and Pendelluft in Patients with Acute Lung Injury: A Narrative Review

Su, Po‐Lan; Zhao, Zhanqi; Ko, Yen-Fen; Chen, Chang-Wen; Cheng, Kuo-Sheng

doi:10.3390/jcm11247449

Cited by 8 publications

(11 citation statements)

References 37 publications

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“…Pendelluft is a phenomenon that air redistributed among various lung regions due to heterogeneous lung mechanics (Su et al 2022). Pendelluft increases in patients with strong inspiration need and require higher ventilation support (Yoshida et al 2016).…”

Section: Discussionmentioning

confidence: 99%

Regional ventilation distribution before and after laparoscopic lung parenchymal resection

Xiao,

Yang,

Dai

et al. 2024

Physiol. Meas.

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Objective:The aim of the present study was to evaluate the influence of one-sided pulmonary nodule and tumour on ventilation distribution pre- and post- partial lung resection.Methods:A total of 40 consecutive patients scheduled for laparoscopic lung parenchymal resection were included. Ventilation distribution was measured with electrical impedance tomography (EIT) in supine and surgery lateral positions 72 hours before surgery (T1) and 48 hours after extubation (T2). Left lung to global ventilation ratio (Fl), the global inhomogeneity index (GI), standard deviation of regional ventilation delay (RVDSD) and pendelluft amplitude (Apendelluft) were calculated to assess the spatial and temporal ventilation distribution.Results:After surgery (T2), ventilation at the operated chest sides generally deteriorated compared to T1 as expected. For right-side resection, the differences were significant at both supine and left lateral positions (p<0.001). RVD was in general more heterogeneous. For left-side resection, RVDSD was worse at T2 compared to T1 at left lateral position (p=0.002). The other EIT-based parameters showed no significant differences between the two time points. No significant differences were observed between supine and lateral positions for the same time points respectively.

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Section: Discussionmentioning

confidence: 99%

Regional ventilation distribution before and after laparoscopic lung parenchymal resection

Xiao,

Yang,

Dai

et al. 2024

Physiol. Meas.

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“…During spontaneous breaths, the aeration of dependent lung units is enhanced due to diaphragm movement, ventilation can become more homogenous, and gas exchange can be improved [ 9 ]. Furthermore, inspiratory efforts redistribute pulmonary blood flow toward the nondependent parts of the lung [ 10 , 11 ]. On the other hand, excessive inspiratory muscle contraction can result in very negative transpulmonary pressures that can move intravascular fluid to interstitial tissue and alveoli, resulting in pulmonary edema [ 12 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure

Akoumianaki

Bolaki

Prinianakis

et al. 2023

JPM

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Hiccups-like contractions, including hiccups, respiratory myoclonus, and diaphragmatic tremor, refer to involuntary, spasmodic, and inspiratory muscle contractions. They have been repeatedly described in mechanically ventilated patients, especially those with central nervous damage. Nevertheless, their effects on patient-ventilator interaction are largely unknown, and even more overlooked is their contribution to lung and diaphragm injury. We describe, for the first time, how the management of hiccup-like contractions was individualized based on esophageal and transpulmonary pressure measurements in three mechanically ventilated patients. The necessity or not of intervention was determined by the effects of these contractions on arterial blood gases, patient-ventilator synchrony, and lung stress. In addition, esophageal pressure permitted the titration of ventilator settings in a patient with hypoxemia and atelectasis secondary to hiccups and in whom sedatives failed to eliminate the contractions and muscle relaxants were contraindicated. This report highlights the importance of esophageal pressure monitoring in the clinical decision making of hiccup-like contractions in mechanically ventilated patients.

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“…The nadir of the impedance of the four ROIs could occur before, in time with, or after the global nadir. Pendelluft was defined as the absolute difference in impedance between the regional nadir and regional impedance at the time of the global nadir, and it was the sum of regional pendelluft values of the four ROIs 7 , 13 .…”

Section: Methodsmentioning

confidence: 99%

Pendelluft in patients with acute respiratory distress syndrome during trigger and reverse triggering breaths

Lin,

Su,

Chen

2023

Sci Rep

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Pendelluft, the shift of air from non-dependent to dependent lung regions, is known to occur during active breathing in ventilated patients. However, information about pendelluft in ARDS patients under assisted mechanical ventilation is limited. In this prospectively collected and retrospectively analyzed study, we combined electrical impedance tomography and respiratory mechanics monitoring to quantitatively examine pendelluft in trigger and reverse triggering breaths in 20 mechanically ventilated patients with ARDS during the transition from controlled to active breaths under volume-cycled ventilation. Besides the 10 resting breaths in each patient, 20% of the counted active breaths were selected based on three levels of esophageal pressure swing (∆Pes): low (< 5 cm H2O, breaths = 471), moderate (≥ 5, < 10 cm H2O, breaths = 906), and high effort (≥ 10 cm H2O, breaths = 565). The pendelluft response to breathing efforts was significantly greater in trigger breaths than in reverse triggering breaths (p < 0.0001). Based on the pendelluft-∆Pes slope (ml/cmH2O), there were two distinct patterns of effort-related pendelluft (high vs. low pendelluft group). For trigger breaths, the high pendelluft group (n = 9, slope 0.7–2.4 ml/cmH2O) was significantly associated with lower peak airway/plateau pressure and lower respiratory system/lung elastance than the low pendelluft group (n = 11, slope − 0.1 to 0.3 ml/cmH2O). However, there was no difference in respiratory mechanics between high and low pendelluft groups for reverse triggering breathes. The use of ∆Pes to predict pendelluft was found to have a low positive predictive value.

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Spontaneous Breathing and Pendelluft in Patients with Acute Lung Injury: A Narrative Review

Cited by 8 publications

References 37 publications

Regional ventilation distribution before and after laparoscopic lung parenchymal resection

Regional ventilation distribution before and after laparoscopic lung parenchymal resection

Hiccup-like Contractions in Mechanically Ventilated Patients: Individualized Treatment Guided by Transpulmonary Pressure

Pendelluft in patients with acute respiratory distress syndrome during trigger and reverse triggering breaths

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