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Table 1 Lung mechanical properties of three patients experiencing acute exacerbation of interstitial lung disease (AE-ILD)

From: Ventilatory support and mechanical properties of the fibrotic lung acting as a “squishy ball”

MeasurementPatient 1 (CHP)Patient 2 (IPF)Patient 3 (CHP)
PEEP titration strategyLung resting strategyOpen lung approachLung resting strategyOpen lung approachLung resting strategyOpen lung approach
Set PEEP (cmH2O)412412412
Driving pressure (cmH2O)17.018.014.518.012.016.0
Transpulmonary pressure (cmH2O)      
 End-inspiratory14.016.79.916.010.013.9
 End-expiratory− 2.20.2− 4.00.3− 1.01.6
 Driving pressure16.216.514.016.311.012.3
Elastance (cmH2O/L)
 Respiratory system44.651.634474043
 Pulmonary42.547.033.045.035.037.9
 Chest wall2.14.61.02.05.05.8
Blood arterial PaO2/FiO2 (mmHg)92781131108579
  1. Patient 1 and 3 presented chronic hypersensitivity pneumonitis (CHF) while patient 2 presented idiopathic pulmonary fibrosis (IPF) In each patient, two PEEP setting strategies were tested: a “lung resting strategy” aimed at minimizing PEEP while maintaining sufficient oxygenation (SpO2 > 88–92%) and an “open lung approach” titrating PEEP aiming at avoiding negative end-expiratory transpulmonary pressure. The negative end-expiratory transpulmonary pressure values achieved at 4 cmH2O PEEP suggest that low levels of PEEP do not prevent tidal alveolar de-recruitment. Nevertheless, higher levels of PEEP determined mild-to-critical increase in lung elastance and non-clinically relevant worsening of gas exchange
  2. PEEP positive end-expiratory pressure