Respiratory failure & ventilation
Airway opening pressure in mechanically ventilated patients: regional distribution and impact of body position
Authors' conclusion
Bedside AOP detection based on the low-flow insufflation method may miss regional AOP, leading to an underestimation of the minimal positive end-expiratory pressure which may be required to avoid tidal opening and closing in some lung regions. The level of regional AOP increases in SP0° compared to SR30° position.
Study context
- Population
- Mechanically ventilated patientsplus 4 Thiel cadavers
- Participants
- 46 participants
- Comparison
- Global vs regional Airway Opening Pressure (AOP); SR30° vs SP0° position
- SP0°n = 23
- Outcome
- Regional distribution of airway opening pressure (AOP) and effect of body position
Methodological detailselectrical impedance tomography, proof-of-concept cadaver experiments
- Electrical impedance tomography
- Proof-of-concept cadaver experiments
Main finding
As reported in the abstract
AOP detection in SR30°
- AOPGLOBAL detected
- 10 patients (22%)
- AOPGLOBAL level, median [IQR]
- 8.4 [6.3-12.0] cmH2O
- AOPVENTRAL detected
- 11 (24%)
- AOPDORSAL detected
- 16 (35%)
- Lowest regional AOP correlated with AOPGLOBAL
- r2 = 0.993, p < 0.001
Further findings
Effect of body position (subgroup with position analysis)
- Highest regional AOP increased from SR30° to SP0°
Cadaver experiments: end-expiratory esophageal pressure vs AOPGLOBAL
- Increase in end-expiratory esophageal pressure with SP0° or increased abdominal pressure correlated with increase in AOPGLOBAL
- r2 = 0.908, p < 0.001
Original publication
Airway opening pressure in mechanically ventilated patients: regional distribution and impact of body position. Crit Care. Published 21 December 2025. doi:10.
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