ArticleAmerican journal of respiratory and critical care medicine2011
Lung stress and strain during mechanical ventilation: any safe threshold?
Article in American journal of respiratory and critical care medicine, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 3 registered trials, which are not on this map. Cited by 164 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Mechanical Ventilation Epidemiology in Argentina. EpVAr Multicenter Study.
REcruitment MAneuvers and Mechanical Ventilation Guided by EIT in Pediatric Acute Respiratory Distress Syndrome (pARDS)
Effects of Low Tidal Volume and Airway Pressure Release Ventilation on Lung Tissue Mechanics in ARDS Patients Under Mechanical Ventilation: A Prospective Randomized Crossover Study
Who cites it
164 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Driving pressure-guided ventilation during one-lung ventilation for thoracic surgery: a systematic review and meta-analysis.Frontiers in medicine · 2026Pooled it
- An Updated Review of Driving-Pressure Guided Ventilation Strategy and Its Clinical Application.BioMed research international · 2022Pooled it
- Lung protective ventilation in patients undergoing major surgery: a systematic review incorporating a Bayesian approach.BMJ open · 2015Pooled it
- Protective mechanical ventilation in the non-injured lung: review and meta-analysis.Critical care (London, England) · 2014Pooled it
- Physiological effects of awake prone position in acute hypoxemic respiratory failure.Critical care (London, England) · 2023Trial
- Respective Effects of Helmet Pressure Support, Continuous Positive Airway Pressure, and Nasal High-Flow in Hypoxemic Respiratory Failure: A Randomized Crossover Clinical Trial.American journal of respiratory and critical care medicine · 2023Trial
- Effect of pressure-controlled ventilation-volume guaranteed mode combined with individualized positive end-expiratory pressure on respiratory mechanics, oxygenation and lung injury in patients undergoing laparoscopic surgery in Trendelenburg position.Journal of clinical monitoring and computing · 2022Trial
- Perioperative Open-lung Approach, Regional Ventilation, and Lung Injury in Cardiac Surgery.Anesthesiology · 2020Trial
- Trial
- The effects of low tidal ventilation on lung strain correlate with respiratory system compliance.Critical care (London, England) · 2017Trial
- Bedside assessment of the effects of positive end-expiratory pressure on lung inflation and recruitment by the helium dilution technique and electrical impedance tomography.Intensive care medicine · 2016Trial
- Cardiac index and oxygen delivery during low and high tidal volume ventilation strategies in patients with acute respiratory distress syndrome: a crossover randomized clinical trial.Critical care (London, England) · 2013Trial
- PEEP and alveolar recruitment after 60 years of acute respiratory distress syndrome.Intensive care medicine · 2026Review
- Bedside Assessment of PEEP-Induced Volume and Mechanical Power in Mechanically Ventilated Adults Without ARDS: A Post Hoc Analysis.Medical sciences (Basel, Switzerland) · 2026Article
- Power, Duration, and Compliance: Reframing Risk of Ventilatory-Induced Lung Injury With the Risk-Adjusted Mechanical-Power Score.Critical care medicine · 2026Article
- The role of mechanical power in lung ventilation for the prevention of ventilator-induced lung injury: a narrative review.European respiratory review : an official journal of the European Respiratory Society · 2026Review
- Estimation of Transpulmonary Driving Pressure, Strain, and Lung-Specific Elastance Using Volumetric Methods in Invasively Ventilated Children-A Feasibility Study.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2026Article
- Ventilator-induced lung injury: from mechanisms to integrated clinical management.Frontiers in medicine · 2026Review
- Physiology-guided personalized mechanical ventilation to prevent ventilator-induced lung injury.Frontiers in medicine · 2026Review
- Rheological Theory Applied to Mechanical Ventilation in Acute Respiratory Distress Syndrome: A New Paradigm for Understanding and Preventing Ventilator-Induced Lung Injury.Journal of clinical medicine · 2025Review
104 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
17 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
rationaleUnphysiologic strain (the ratio between tidal volume and functional residual capacity) and stress (the transpulmonary pressure) can cause ventilator-induced lung damage.
objectivesTo identify a strain-stress threshold (if any) above which ventilator-induced lung damage can occur.
methodsTwenty-nine healthy pigs were mechanically ventilated for 54 hours with a tidal volume producing a strain between 0.45 and 3.30. Ventilator-induced lung damage was defined as net increase in lung weight. MEASUREMENTS AND MAIN
resultsInitial lung weight and functional residual capacity were measured with computed tomography. Final lung weight was measured using a balance. After setting tidal volume, data collection included respiratory system mechanics, gas exchange and hemodynamics (every 6 h); cytokine levels in serum (every 12 h) and bronchoalveolar lavage fluid (end of the experiment); and blood laboratory examination (start and end of the experiment). Two clusters of animals could be clearly identified: animals that increased their lung weight (n = 14) and those that did not (n = 15). Tidal volume was 38 ± 9 ml/kg in the former and 22 ± 8 ml/kg in the latter group, corresponding to a strain of 2.16 ± 0.58 and 1.29 ± 0.57 and a stress of 13 ± 5 and 8 ± 3 cm H(2)O, respectively. Lung weight gain was associated with deterioration in respiratory system mechanics, gas exchange, and hemodynamics, pulmonary and systemic inflammation and multiple organ dysfunction.
conclusionsIn healthy pigs, ventilator-induced lung damage develops only when a strain greater than 1.5-2 is reached or overcome. Because of differences in intrinsic lung properties, caution is warranted in translating these findings to humans.
Indexed as
Identifiers
21297069What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.