ReviewJournal of intensive care2015
The role of spontaneous effort during mechanical ventilation: normal lung versus injured lung.
Review in Journal of intensive care, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03513809 (Spontaneous Breathing and Progression of Lung Injury in Acute Respiratory Distress Syndrome Before Connection to Mechanical Ventilation), which is not on this map. Cited by 24 papers.
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.
Spontaneous Breathing and Progression of Lung Injury in Acute Respiratory Distress Syndrome Before Connection to Mechanical Ventilation
Who cites it
24 citing papers in PubMed.
- Surface electromyography to quantify neuro-respiratory drive and neuro-mechanical coupling in mechanically ventilated children.Respiratory research · 2023Trial
- Effects of two ventilator-weaning methods on lung volume and ventilation distribution by electrical impedance tomography in post-cardiac surgery patients: a prospective cohort study.Journal of intensive care · 2026Article
- Developing A Data Pipeline to Quantify Ventilator Waveforms.medRxiv : the preprint server for health sciences · 2025Article
- Debate on the Role of Eccentric Contraction of the Diaphragm: Is It Always Harmful?Healthcare (Basel, Switzerland) · 2025Article
- What every paediatrician needs to know about mechanical ventilation.European journal of pediatrics · 2024Review
- The impact of aggressive and conservative propensity for initiation of neuromuscular blockade in mechanically ventilated patients with hypoxemic respiratory failure.Journal of critical care · 2024Article
- Clinical and Experimental Evidence for Patient Self-Inflicted Lung Injury (P-SILI) and Bedside Monitoring.Journal of clinical medicine · 2024Review
- Occurrence of pendelluft during ventilator weaning with T piece correlated with increased mortality in difficult-to-wean patients.Journal of intensive care · 2024Article
- Advanced Respiratory Monitoring during Extracorporeal Membrane Oxygenation.Journal of clinical medicine · 2024Review
- Assessment of Inspiratory Effort in Spontaneously Breathing COVID-19 ARDS Patients Undergoing Helmet CPAP: A Comparison between Esophageal, Transdiaphragmatic and Central Venous Pressure Swing.Diagnostics (Basel, Switzerland) · 2023Article
- Understanding clinical and biological heterogeneity to advance precision medicine in paediatric acute respiratory distress syndrome.The Lancet. Respiratory medicine · 2023Review
- Anesthetic (r)evolution from the conventional concept to the minimally invasive techniques in thoracic surgery-narrative review.Journal of thoracic disease · 2022Review
- Estimating the incidence of spontaneous breathing effort of mechanically ventilated patients using a non-linear auto regressive (NARX) model.Computer methods and programs in biomedicine · 2022Article
- Risk Factors for Pulmonary Air Leak and Clinical Prognosis in Patients With COVID-19 Related Acute Respiratory Failure: A Retrospective Matched Control Study.Frontiers in medicine · 2022Article
- Awake Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: Which Clinical Issues Should Be Taken Into Consideration.Frontiers in medicine · 2021Review
- Use of neurally adjusted ventilatory assist (NAVA) in a patient with severe SARS-CoV-2 pneumonia: A case report.Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR · 2021Article
- Non-intubated Thoracoscopic Surgery-Tips and Tricks From Anesthesiological Aspects: A Mini Review.Frontiers in surgery · 2021Review
- A physiological approach to understand the role of respiratory effort in the progression of lung injury in SARS-CoV-2 infection.Critical care (London, England) · 2020Review
- Progression of regional lung strain and heterogeneity in lung injury: assessing the evolution under spontaneous breathing and mechanical ventilation.Annals of intensive care · 2020Article
- Assessing breathing effort in mechanical ventilation: physiology and clinical implications.Annals of translational medicine · 2018Review
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The role of preserving spontaneous effort during mechanical ventilation and its interaction with mechanical ventilation have been actively investigated for several decades. Inspiratory muscle activities can lower the pleural components surrounding the lung, leading to an increase in transpulmonary pressure when spontaneous breathing effort is preserved during mechanical ventilation. Thus, increased transpulmonary pressure provides various benefits for gas exchange, ventilation pattern, and lung aeration. However, it is important to note that these beneficial effects of preserved spontaneous effort have been demonstrated only when spontaneous effort is modest and lung injury is less severe. Recent studies have revealed the 'dark side' of spontaneous effort during mechanical ventilation, especially in severe lung injury. The 'dark side' refers to uncontrollable transpulmonary pressure due to combined high inspiratory pressure with excessive spontaneous effort and the injurious lung inflation pattern of Pendelluft (i.e., the translocation of air from nondependent lung regions to dependent lung regions). Thus, during the early stages of severe ARDS, the strict control of transpulmonary pressure and prevention of Pendelluft should be achieved with the short-term use of muscle paralysis. When there is preserved spontaneous effort in ARDS, spontaneous effort should be maintained at a modest level, as the transpulmonary pressure and the effect size of Pendelluft depend on the intensity of the spontaneous effort.
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