Trial reportCritical care (London, England)2025
The "mechanical paradox" unveiled: a physiological study.
Trial report in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06174636 (Lung Overdistension and Abdominal Pressure Rise), which is not on this map. Cited by 1 paper.
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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.
Lung Overdistension and Abdominal Pressure Rise: an EIT Based Pilot Study
Who cites it
1 citing paper in PubMed.
- Real-time stress and strain monitoring at the bedside: new frontiers in mechanical ventilation.Frontiers in medicine · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRecent studies report that chest wall loading may reduce airway pressures and increase respiratory system compliance, contrary to the anticipated effect of this maneuver ("mechanical paradox"). Aim of this physiological study is to clarify the mechanism underlying this phenomenon.
methodsTwenty patients receiving invasive mechanical ventilation for acute hypoxemic respiratory failure were studied during a decremental PEEP trial. Variable weights were placed on the patients' abdomen to achieve a 5-mmHg increase in intra-abdominal pressure. Three consecutive phases for each PEEP level were performed: weight-off, weight-on, and weight-off. Esophageal pressure measurement and electrical impedance tomography (EIT) were used.
resultsThe abdominal weight decreased end-expiratory lung impedance (EELI) and overdistention and increased collapse for all PEEP values (all p-values < 0.001). For PEEP values higher than the EIT-based optimal PEEP, the abdominal weight reduced respiratory system and lung plateau pressures (coefficient [standard error] - 1.26 [0.21] and - 5.51 [0.28], respectively, both p-values < 0.001) and driving pressures (- 1.47 [0.22] and - 1.62 [0.22], respectively, both p-values < 0.001). For PEEP values lower than the optimal, the effect of the application of the abdominal weight was the opposite (all p-values < 0.001).
conclusionsThe improvement in respiratory system and lung mechanics following abdominal loading is consequent to the reduction of end-expiratory lung volume. This effect, however, only occurs at PEEP levels associated with prevalent overdistention. This simple and safe maneuver could be applied at the bedside to identify lung overdistension and titrate PEEP.
trial registrationClinicalTrials.gov (NCT06174636, July 9th 2023).
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