Is Transpulmonary Pressure well enough understood?
Mechanical ventilation in the intensive care unit (ICU) is usually guided by arterial blood gases, and the parameters
used to maintain these blood gases are limited by standards for lung protective ventilation.1 Airway pressures and tidal
volume are minimized for lung protection despite evidence that they may be inadequate surrogates for lung stress
and strain.2 Transpulmonary pressure represents true lung pressure, and physiologically is ≥ 0 cmH2O at end-exhalation.
Transpulmonary pressure < 0 cmH2O results in a lower FRC, lower compliance, and airways are prone to collapse on exhalation.3 The respiratory therapists hypothesized that a patient admitted to St. Joseph’s Healthcare ICU from an external facility was being ventilated with insufficient positive end-expiratory pressure (PEEP), causing a negative transpulmonary pressure. Click on the following video http://bit.ly/Hsl9Yd