title: Work of breathing-tidal volume relationship: analysis on an in vitro model and clinical implications.
abstract: OBJECTIVE
  Work of breathing (WoB) is currently employed to assess the afterload on the respiratory muscles and to estimate the energy expenditure for breathing. Since WoB depends on the ventilated tidal volume (TV), WoB*L(-1), the indicized form of WoB has been employed as a measure of WoB which is independent of TV. Actually, the independence of WoB*L(-1) from the ventilated TV has never been demonstrated. The aim of this study was to verify the predicted TV-independence of WoB*L(-1) on an in vitro model.
  
  
  METHODS
  Our experimental model was constituted as follows: two endotracheal tubes, with internal diameter measuring respectively 6.5 and 8.5 mm, were alternatively connected with two rubber balloons whose compliance was respectively 0.02 and 0.06 L/hPa; the system was mechanically ventilated at ten different tidal volumes, ranging from 0.3-1 l. Flow rate was kept constant (35 l/m) during the whole experiment.
  
  
  RESULTS
  Both elastic components of the model showed a static volume-pressure relationship which was linear in the experimental range of TV. In all combinations of resistance and compliance WoB increased quadratically whereas WoB*L(-1) increased linearly with the growing TV (p < 0.001).
  
  
  CONCLUSIONS
  These results demonstrate the TV-dependence of WoB*L(-1) and suggest that WoB*L(-1), if TV changes, cannot be considered as an index of respiratory muscle afterload and should not be used as a guide for weaning patients from the mechanical ventilation. Finally, we introduced a new parameter (WoB1L) which seems to be a more TV-independent measure of respiratory work.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Poliambulanza Hospital, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Natalini
authors.forename: D M
authors.initials: DM
authors.lastname: Tuzzo
authors.forename: G
authors.initials: G
authors.lastname: Comunale
authors.forename: F A
authors.initials: FA
authors.lastname: Rasulo
authors.forename: G
authors.initials: G
authors.lastname: Amicucci
authors.forename: A
authors.initials: A
authors.lastname: Candiani
mesh_terms: D006801:Humans; D008170:Lung Compliance; D008954:Models, Biological; D008961:Models, Structural; D012121:Respiration, Artificial; D015656:Respiratory Mechanics; D013990:Tidal Volume; D014939:Work of Breathing