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. 2020 Jul 28;24:467. doi: 10.1186/s13054-020-03169-x

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© The Author(s) 2020

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 1 — Waveform analysis of end-inspiratory occlusion. Representative waveforms of flow (in l s), airway (Paw), esophageal (Pes), transdiaphragmatic (Pdi), and gastric (Pga) pressures (in cmH₂O), from one patient, with an end-inspiratory occlusion on the second breath. The blue-shaded area indicates the mechanical inspiratory time, and the yellow-shaded area indicates the end-inspiratory occlusion. Horizontal black arrows indicate the start and end of neural inspiration (T_in) and expiration (T_En). The point of rapid decline of Pdi (end of neural inspiration) is indicated by the blue vertical line, and the horizontal blue double-headed arrow in Paw indicates the cycling off delay. The small black arrows in Pdi indicate the point of complete relaxation of the diaphragm. Black vertical dashed lines indicate the points at 0.3, 1, and 2 s post-occlusion. The thick black arrow in Paw shows the end of the plateau by the sudden decrease in Paw, due to diaphragmatic contraction during occlusion. Observe that the neural inspiratory and expiratory times are similar in the un-occluded and occluded breath, and the occlusion time is less than 2 s. Expiratory muscle activity is indicated by the rise of Pga, during expiration in the un-occluded breath, and during the end-inspiratory occlusion (blue double-headed arrows show the maximum change). Notice also the decrease of Pga at the onset of inspiration, suggesting the relaxation of expiratory muscles at this point (open arrows)