Skip to main content
. 2021 Mar 1;203(5):575–584. doi: 10.1164/rccm.201909-1687OC

Figure 4.

Figure 4.

Swine study. Effect of different numbers of transpulmonary pressure (Pl; during respiratory cycles and during an expiratory pause) on the transmural (TM) right ventricular (RV) and left ventricular (LV) pressure in one healthy swine with normal pleural pressure and in one swine with induced acute respiratory distress syndrome (ARDS) with high pleural pressure due to increased abdominal loading. (A) Healthy swine with normal pleural pressure. Pl, TM RV pressure, and TM LV pressure at low-airway-pressure ventilation with positive end-expiratory pressure (PEEP) = 7 cm H2O (LungPEEP7) and after a lung recruitment maneuver followed by PEEP = 19 cm H2O (LungPEEP19) are shown. TM RV pressure remained unaltered, and TM LV pressure showed a significant drop during the increase in Pl from LungPEEP7 to LungPEEP19 (black arrow). (B) Swine with induced ARDS with high pleural pressure due to increased abdominal loading. Pl, TM RV pressure, and TM LV pressure at LungCOLLAPSED and LungRECRUITED are shown. TM RV pressure expressively dropped (black arrow), and TM LV pressure did not change with the increase in Pl. LungCOLLAPSED = low airway pressure to promote alveolar derecruitment; LungRECRUITED = a sequence of procedures (lung recruitment maneuver → decremental PEEP trial → second lung recruitment maneuver → optimal PEEP) to recruit lung atelectasis.