Figures
- Figure 1.
a) Breath-holding end-expiration: pleural (Ppl) and transpulmonary (Ptp) pressures in normal subject at the end of expiration. When the glottis is open and there is no flow at the mouth (breath-holding) the alveolar pressure is in equilibrium with atmospheric pressure. b) Inspiration: Ppl and Ptp during inspiration in a normal subject. Ppl becomes more negative with the inspiratory efforts. Alveolar pressure becomes lower than atmospheric pressure allowing air to flow from the atmosphere to the alveoli. c) Breath-holding at end-inspiration: Ppl and Ptp at the end of inspiration with breath-hold. Lung volume has increased by accommodating the tidal volume and Ptp is greater than at the end of expiration. d) Inspiration: complete and fixed upper airway obstruction. There is no communication between the atmosphere and the alveoli. The changes in Ppl are transmitted to the alveoli but the lung volume does not change. The hydrostatic microvascular pressure gradient between lung capillaries (red) and alveoli increases promoting an increase in fluid filtration across the alveolar-to-capillary membrane (arrow). e) End-inspiration: Ppl and Ptp in a patient receiving a low level of pressure support ventilation. The high Ptp values that would result from this condition may not be recognised as Ppl is not routinely measured in the intensive care unit. The key variable to monitor in such situations, in the perspective of ventilator-induced lung injury prevention, is the expired tidal volume that must be maintained at ∼6 mL·kg−1 predicted body weight. Numbers within the lung refer to alveolar pressure, and those at the proximal tube refer to atmospheric pressue.
- Figure 2.
Occlusion test to ascertain the correct position of the oesophageal balloon in the thorax of a pig. a) Trace of airway pressure (Pao), oesophageal pressure (Poes) and transpulmonary pressure (Ptp), and b) flow in a pig that has been tracheotomised and is being mechanically ventilated. At the time indicated (a, arrow), the airways were occluded and the animal developed very high atmospheric pressure, during which time there was no change in flow and, therefore, in lung volume. The change in Poes parallels that in Pao, validating the good position of the oesophageal device. It can be seen that Ptp does not change (unpublished observation).
