Targeting transpulmonary pressure to prevent ventilator-induced lung injury

Expert Rev Respir Med. 2019 Aug;13(8):737-746. doi: 10.1080/17476348.2019.1638767. Epub 2019 Jul 5.


Introduction: Transpulmonary pressure (PL) is the pressure distending the lung. This pressure equals the stress which develops into the parenchyma at each insufflation and it depends, for a given airway pressure, on the relationship between the lung and the chest wall elastance: a given stress is associated to a given strain, therefor PL is strictly related to ventilator-induced lung injury (VILI). Insufficient knowledge and increased workload account for its limited use in the clinical setting: indeed, the current recommendations for protective ventilation still rely only on the pressures applied to the respiratory system in total (Plateau pressure), without a direct measurement of the real lung stress. Areas covered: We reviewed the significance, the assessment, the application and the limits of transpulmonary pressure in the clinical setting. Expert opinion: Transpulmonary pressure represents a physiologically sound safety limit for mechanical ventilation that should be measured and targeted at least in the most severe ARDS patients. Targeting transpulmonary pressure means 'personalizing' the ventilatory settings.

Keywords: ARDS; VILI; esophageal pressure; mechanical ventilation; pleural pressure; stress; transpulmonary pressure.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Humans
  • Respiration, Artificial
  • Ventilator-Induced Lung Injury / prevention & control*