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http://dx.doi.org/10.1164/rccm.202312-2274LEDOI Listing

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The intensity of respiratory treatment in acute respiratory distress syndrome (ARDS) is traditionally adjusted based on oxygenation severity, as defined by the mild, moderate, and severe Berlin classifications. However, ventilator-induced lung injury (VILI) is primarily determined by ventilator settings, namely tidal volume, respiratory rate, and positive end-expiratory pressure (PEEP). All these variables, along with respiratory elastance, are included in the concept of mechanical power.

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Background: During control mechanical ventilation (CMV), the driving pressure of the respiratory system (ΔP) serves as a surrogate of transpulmonary driving pressure (ΔP). Expiratory muscle activity that decreases end-expiratory lung volume may impair the validity of ΔP to reflect ΔP. This prospective observational study in patients with acute respiratory distress syndrome (ARDS) ventilated with proportional assist ventilation (PAV+), aimed to investigate: (1) the prevalence of elevated ΔP, (2) the ΔP-ΔP relationship, and (3) whether dynamic transpulmonary pressure (Plung) and effort indices (transdiaphragmatic and respiratory muscle pressure swings) remain within safe limits.

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