ArticleCritical care (London, England)2023
Tidal lung hysteresis to interpret PEEP-induced changes in compliance in ARDS patients.
Article in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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13 citing papers in PubMed, 16 citations in OpenAlex.
- PEEP and alveolar recruitment after 60 years of acute respiratory distress syndrome.Intensive care medicine · 2026Review
- Determinants of tidal recruitment/derecruitment assessed by electrical impedance tomography in spontaneously breathing acute respiratory distress syndrome patients.American journal of respiratory and critical care medicine · 2026Article
- Mechanical Power as a Predictor of Outcomes During Mechanical Ventilation in Coronavirus Disease 2019 (COVID-19): An Updated Systematic Review.Journal of clinical medicine · 2026Review
- Injury Mechanics in Surfactant-Depleted and Healthy Rat Lungs: A Multi-scale Consideration of Artificial and Physiological Ventilation.Annals of biomedical engineering · 2026Article
- Lung recruitability determines the impact of PEEP on mechanical power in ARDS.Critical care (London, England) · 2026Article
- Effects of driving pressure-guided lung-protective ventilation strategy on respiratory mechanics, oxygenation, and postoperative pulmonary complications in patients undergoing minimally invasive esophagectomy: a randomized clinical trial.Journal of thoracic disease · 2025Article
- Lung injury promoted by strong inspiratory efforts and breath stacking: impact of ventilation mode.Intensive care medicine experimental · 2025Article
- The Titans' Challenge: The Cross-influence of Heart-Lung and Cerebral Dynamics in Recruitment Maneuver.Neurocritical care · 2025Article
- Bedside Assessment of the Respiratory System During Invasive Mechanical Ventilation.Journal of clinical medicine · 2024Review
- Determination of positive end-expiratory pressure in COVID-19-related acute respiratory distress syndrome: A systematic review.European journal of anaesthesiology and intensive care · 2024Article
- Correlation between normally aerated lung and respiratory system compliance at clinical high positive end-expiratory pressure in patients with COVID-19.Scientific reports · 2024Article
- Contribution of electrical impedance tomography to personalize positive end-expiratory pressure under ECCOCritical care (London, England) · 2024Article
- Lung elastance and PEEP level with lowest transpulmonary driving pressure can be determined by a rapid PEEP step procedure without esophageal pressure measurements.Critical care (London, England) · 2023Article
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn ARDS, the PEEP level associated with the best respiratory system compliance is often selected; however, intra-tidal recruitment can increase compliance, falsely suggesting improvement in baseline mechanics. Tidal lung hysteresis increases with intra-tidal recruitment and can help interpreting changes in compliance. This study aims to assess tidal recruitment in ARDS patients and to test a combined approach, based on tidal hysteresis and compliance, to interpret decremental PEEP trials.
methodsA decremental PEEP trial was performed in 38 COVID-19 moderate to severe ARDS patients. At each step, we performed a low-flow inflation-deflation manoeuvre between PEEP and a constant plateau pressure, to measure tidal hysteresis and compliance.
resultsAccording to changes of tidal hysteresis, three typical patterns were observed: 10 (26%) patients showed consistently high tidal-recruitment, 12 (32%) consistently low tidal-recruitment and 16 (42%) displayed a biphasic pattern moving from low to high tidal-recruitment below a certain PEEP. Compliance increased after 82% of PEEP step decreases and this was associated to a large increase of tidal hysteresis in 44% of cases. Agreement between best compliance and combined approaches was accordingly poor (K = 0.024). The combined approach suggested to increase PEEP in high tidal-recruiters, mainly to keep PEEP constant in biphasic pattern and to decrease PEEP in low tidal-recruiters. PEEP based on the combined approach was associated with lower tidal hysteresis (92.7 ± 20.9 vs. 204.7 ± 110.0 mL; p < 0.001) and lower dissipated energy per breath (0.1 ± 0.1 vs. 0.4 ± 0.2 J; p < 0.001) compared to the best compliance approach. Tidal hysteresis ≥ 100 mL was highly predictive of tidal recruitment at next PEEP step reduction (AUC 0.97; p < 0.001).
conclusionsAssessment of tidal hysteresis improves the interpretation of decremental PEEP trials and may help limiting tidal recruitment and energy dissipated into the respiratory system during mechanical ventilation of ARDS patients.
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