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Monitoring Lung Mechanics : New Applications for Established Tools

Ahmet Baydur, MD, FCCP
Author and Funding Information

Affiliations: Los Angeles, CA 
 ,  Dr. Baydur is a member of the Division of Pulmonary and Critical Care Medicine, University of Southern California School of Medicine.

Correspondence to: Ahmet Baydur, MD, FCCP, University of Southern California, Keck School of Medicine, 2025 Zonal Ave, GNH 11-900, Los Angeles, CA 90033



Chest. 2002;121(2):324-326. doi:10.1378/chest.121.2.324
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Pressures measured at the various boundaries of the respiratory system include the pressure at the airway opening (Paw), alveolar pressure (considered equal to Paw if there is no gas flow and the glottis remains open), and pleural pressure (Ppl). During static and dynamic respiratory maneuvers, it is possible to measure the pressure across the lung (transpulmonary pressure [Ptp]) by measuring the difference between Paw and Ppl. The latter has been measured with needles, trocars, catheters, and most commonly balloons. Only a few direct comparisons of Ppl and esophageal pressure (Pes) have been made.1 These generally show good agreement, except that pressure swings recorded by the balloon technique are larger in the lower third of the esophagus, near the diaphragm. Monitoring total respiratory mechanics (as a reflection of lung mechanics) in patients with acute lung injury or labile airway obstruction (by recording tidal volume and Paw) assumes that the chest wall (ie, rib cage plus abdominal) component remains constant. In fact, this may not be the case in patients with ascites, pregnancy, peritonitis, pleural effusions, or the abdominal compartment syndrome, which result in a reduction of chest wall and, hence, total respiratory compliance. Thus, separately recording Ppl and deriving Ptp from this value allow one to determine if changes in total respiratory compliance are due to changes in lung or chest wall elasticity. In addition, measurement of work of breathing can only be accomplished by recording Ppl (or a reasonable surrogate).

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