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Review

Bench-to-bedside review: Chest wall elastance in acute lung injury/acute respiratory distress syndrome patients

Luciano Gattinoni*, Davide Chiumello, Eleondra Carlesso and Franco Valenza

Author Affiliations

Institute of Anesthesia and Critical Care, University of Milan, Policlinico – IRCCS Hospital, Milan, Italy

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Critical Care 2004, 8:350-355  doi:10.1186/cc2854

Published: 7 May 2004

Abstract

The importance of chest wall elastance in characterizing acute lung injury/acute respiratory distress syndrome patients and in setting mechanical ventilation is increasingly recognized. Nearly 30% of patients admitted to a general intensive care unit have an abnormal high intra-abdominal pressure (due to ascites, bowel edema, ileus), which leads to an increase in the chest wall elastance. At a given applied airway pressure, the pleural pressure increases according to (in the static condition) the equation: pleural pressure = airway pressure × (chest wall elastance/total respiratory system elastance). Consequently, for a given applied pressure, the increase in pleural pressure implies a decrease in transpulmonary pressure (airway pressure – pleural pressure), which is the distending force of the lung, implies a decrease of the strain and of ventilator-induced lung injury, implies the need to use a higher airway pressure during the recruitment maneuvers to reach a sufficient transpulmonary opening pressure, implies hemodynamic risk due to the reductions in venous return and heart size, and implies a possible increase of lung edema, partially due to the reduced edema clearance. It is always important in the most critically ill patients to assess the intra-abdominal pressure and the chest wall elastance.

Keywords:
acute respiratory distress syndrome; chest wall elastance; intra-abdominal pressure; pleural pressure; ventilator-induced lung injury