ArticlePediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies2026
Estimation of Transpulmonary Driving Pressure, Strain, and Lung-Specific Elastance Using Volumetric Methods in Invasively Ventilated Children-A Feasibility Study.
Article in Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo study the feasibility of integrating the nitrogen multiple breath wash-in/washout (NMBW) technique with the positive end-expiratory pressure-step (PEEP-step) method to estimate transpulmonary driving pressure (DP TP ), strain, and lung-specific elastance ( k ).
designProspective feasibility physiology study.
settingNational board-affiliated 30-bed quaternary care hospital PICU. PATIENTS: Invasively ventilated children from 2 months to 16 years old between December 1, 2021, and August 30, 2022.
interventionsIn volume-control mode, functional residual capacity (FRC) was measured using the NMBW technique at zero end-expiratory pressure (ZEEP), and end-expiratory lung volume was measured during the PEEP-step method. MEASUREMENTS AND
resultsData from 33 of 63 eligible subjects were analyzed, of whom 18 of 33 had pediatric acute respiratory distress syndrome (PARDS). Median (interquartile range [IQR]) FRC normalized to body weight was 15.1 mL/kg (IQR, 10.6-20.4 mL/kg). A correlation was found between FRC and respiratory compliance at ZEEP (rho = 0.775; p < 0.001). Strain demonstrated a positive correlation with both the DP TP (rho = 0.55; p < 0.001) and plateau pressure (rho = 0.72; p < 0.001) at ZEEP. Median k was lower in PARDS than non-PARDS subjects (16.1 cm H 2 O [IQR, 10.8-18.6 cm H 2 O] vs. 19.84 cm H 2 O [IQR, 18.50-23.93 cm H 2 O]; p = 0.045), but this difference was not present when k was normalized to body weight and height.
conclusionsDespite technical limitations, it appears possible to estimate DP TP , strain, and k by integrating the PEEP-step and NMBW methods. Validation against the gold standard esophageal pressure manometry is warranted.
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