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The routine management of mechanical ventilation in the ICU includes monitoring of peak airway pressures, plateau pressures and determining airway resistance.
When volume or pressure is pushed through an airway, a peak pressure is generated. This peak pressure is the sum of the amount of pressure necessary to get through the airways, inflate the alveoli and displace the chest wall and diaphragm. An inspiratory hold is performed on the ventilator to measure how much this pressure (plateau pressure) is actually being sensed in the alveoli once the lungs are inflated. By subtracting the plateau pressure from the peak pressure, we can calculate the resistance from the airways.
In managing mechanical ventilation, we routinely look at the plateau pressure to determine the limits to which we can increase our ventilating volumes. For the majority of patients, the chest wall and diaphragm are relatively compliant so are not a major factor in ability to ventilate patients. In cases of stiff chest wall or distended abdomens, the plateau pressure may be misleading as the pressure sensed within the alveoli is in part due to the pressures from the stiff chest wall or diaphragm.
Recently, esophageal catheters have been used to help optimize ventilation of patients with concerns re. stiff chest walls or diaphragms (distended abdomens). A catheter inserted in the esophagus is in close proximity to the pleural space. Esophageal pressures can be used as a surrogate to pleural pressures. Use of esophageal pressure monitoring can then help to differentiate between:

o pressure in the pleural space, attributable to chest wall and diaphragm and
o pressure distending the lungs (transpulmonary pressure) which might result in barotrauma

Ptpt (transpulmonary) = Paw (plateau) – Pes (esophageal)

continue reading…

Pleurisy, also known as pleuritis, is a condition that results from the swelling of the linings of the lungs and chest. The pleural cavity (area between lungs and inner chest wall) is created by two lubricated surfaces called pleura, the inner pleura lining the lungs and the outer lining the chest wall. A variety of factors can cause the pleura to become inflamed and rub against one another, rather than slide smoothly, as one breathes.

What causes pleurisy?

Pleurisy is a common complication of several different medical conditions, the most pervasive being a viral infection of the lower respiratory system.

Other causes include:

Bacterial infections such as pneumonia and tuberculosis

A chest wound that punctured the pleural cavity

A pleural tumor

Autoimmune disorders like lupus and rheumatoid arthritis

Sickle cell anemia

Pancreatitis

Pulmonary embolism

A heart surgery complication

Lung cancer or lymphoma

A fungal or parasitic infection

Familial Mediterranean fever

Infections can sometimes spread from person to person, but it is rare to “catch” pleurisy.

Sourced from: Respiratory / Asthma News From Medical News Today

Pneumothorax

• Definition

Air accumulation in the pleural space with secondary lung

collapse

• Sources

–Visceral pleura

–Ruptured esophagus

–Chest wall defect

–Gas-forming organisms

• Factors determining gasreabsorption

–Diffusion properties of the gases

–Pressure gradients

–Area of contact

–Permeability of pleural surface

Read Further:

Pneumothorax and Chest Tubes PDF

….Respiratory support should only be delivered when the patient wants it. Traditionally, it has been a matter of supplying a ventilation support that sustains a certain level of minute ventilation, but the ventilator must take care of the lung, chest wall and abdomen, and the work of breathing increases. The patient does not receive what he needs…..

Acuity Care Technology (read more)

Dr. Christer Sinderby with a demonstration of NAVA

in operation at the Maquet Booth at the Las Vegas Conference.