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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”

Measurement Patient 1 (CHP) Patient 2 (IPF) Patient 3 (CHP)
PEEP titration strategy Lung resting strategy Open lung approach Lung resting strategy Open lung approach Lung resting strategy Open lung approach
Set PEEP (cmH2O) 4 12 4 12 4 12
Driving pressure (cmH2O) 17.0 18.0 14.5 18.0 12.0 16.0
Transpulmonary pressure (cmH2O)       
 End-inspiratory 14.0 16.7 9.9 16.0 10.0 13.9
 End-expiratory − 2.2 0.2 − 4.0 0.3 − 1.0 1.6
 Driving pressure 16.2 16.5 14.0 16.3 11.0 12.3
Elastance (cmH2O/L)
 Respiratory system 44.6 51.6 34 47 40 43
 Pulmonary 42.5 47.0 33.0 45.0 35.0 37.9
 Chest wall 2.1 4.6 1.0 2.0 5.0 5.8
Blood arterial PaO2/FiO2 (mmHg) 92 78 113 110 85 79
  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