title: Physiological effects of an open lung ventilatory strategy titrated on elastance-derived end-inspiratory transpulmonary pressure: study in a pig model*.
abstract: BACKGROUND
  In the presence of increased chest wall elastance, the airway pressure does not reflect the lung-distending (transpulmonary) pressure.
  
  
  OBJECTIVE
  To compare the physiological effects of a conventional open lung approach titrated for an end-inspiratory airway opening plateau pressure (30 cm H2O) with a transpulmonary open lung approach titrated for a elastance-derived end-inspiratory plateau transpulmonary pressure (26 cm H2O), in a pig model of acute respiratory distress syndrome (HCl inhalation) and reversible chest wall mechanical impairment (chest wall and abdomen restriction).
  
  
  METHODS
  In eight pigs, physiological parameters and computed tomography were recorded under three conditions: 1) conventional open lung approach, normal chest wall; 2) conventional open lung approach, stiff chest wall; and 3) transpulmonary open lung approach, stiff chest wall.
  
  
  RESULTS
  As compared with the normal chest wall condition, at end-expiration non aerated lung tissue weight was increased by 116 ± 68 % during the conventional open lung approach and by 28 ± 41 % during the transpulmonary open lung approach (p < .01), whereas cardiac output was decreased by 27 ± 19 % and 22 ± 14 %, respectively (p = not significant).
  
  
  CONCLUSIONS
  In this model, the end-inspiratory transpulmonary open lung approach minimized the impact of chest wall stiffening on alveolar recruitment without causing hemodynamic impairment.
authors.affiliation: Dipartimento dell'Emergenza e Trapianti d'Organo, Sezione di Chirurgia Veterinaria, Università degli Studi Aldo Moro, Bari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Staffieri
authors.forename: Tania
authors.initials: T
authors.lastname: Stripoli
authors.forename: Valentina
authors.initials: V
authors.lastname: De Monte
authors.forename: Antonio
authors.initials: A
authors.lastname: Crovace
authors.forename: Marianna
authors.initials: M
authors.lastname: Sacchi
authors.forename: Michele
authors.initials: M
authors.lastname: De Michele
authors.forename: Paolo
authors.initials: P
authors.lastname: Trerotoli
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Terragni
authors.forename: V Marco
authors.initials: VM
authors.lastname: Ranieri
authors.forename: Salvatore
authors.initials: S
authors.lastname: Grasso
mesh_terms: D055371:Acute Lung Injury / Q000628:therapy; D000818:Animals; D001810:Blood Volume; D002245:Carbon Dioxide / Q000097:blood; D002302:Cardiac Output; D045422:Continuous Positive Airway Pressure; D004195:Disease Models, Animal; D008176:Lung Volume Measurements; D010100:Oxygen / Q000097:blood; D011175:Positive-Pressure Respiration / Q000379:methods*; D013902:Radiography, Thoracic; D013318:Stroke Volume; D013552:Swine; D014057:Tomography, X-Ray Computed
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen