A key limitation of mechanical ventilators is that they do not measure the Ptp or pleural pressure. Airway pres- sure alone cannot distinguish poor lung compliance from poor chest-wall compliance. High intra-abdominal pres- sure can severely impair chest wall mechanics.9,10 We used esophageal balloon manometry to estimate Ptp and guide optimal PEEP in a patient suspected of having decreased lung compliance due to intra-abdominal hypertension.
Depending on the chest wall contribution to respiratory mechanics, a given PEEP level or plateau pressure may be adequate for one patient but potentially injurious for another…
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