Respiratory failure & ventilation
The “mechanical paradox” unveiled: a physiological study
Authors' conclusion
The 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.
Study context
- Population
- Patients receiving invasive mechanical ventilation for acute hypoxemic respiratory failure
- Participants
- 20 patients
- Comparison
- Abdominal weight on vs off
- Outcome
- Effects of abdominal weight
Methodological detailsphysiological study, decremental PEEP trial, esophageal pressure and electrical impedance tomography (EIT) measurement
- Physiological study
- Decremental PEEP trial
- Esophageal pressure and EIT measurement
Main finding
As reported in the abstract
- Decreased end-expiratory lung impedance (EELI) and overdistention, increased collapse, for all PEEP values
- all p-values < 0.001
- PEEP above EIT-based optimal PEEP: reduced respiratory system plateau pressure, coefficient [SE]
- - 1.26 [0.21]
- PEEP above EIT-based optimal PEEP: reduced lung plateau pressure, coefficient [SE]
- - 5.51 [0.28]
- PEEP above EIT-based optimal PEEP: reduced respiratory system driving pressure, coefficient [SE]
- - 1.47 [0.22]
- PEEP above EIT-based optimal PEEP: reduced lung driving pressure, coefficient [SE]
- - 1.62 [0.22]
- PEEP below optimal: opposite effect of abdominal weight
- all p-values < 0.001
Original publication
The “mechanical paradox” unveiled: a physiological study. Crit Care. Published 16 May 2025. doi:10.
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