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Monitoring of Respiratory Mechanics

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Andrea Aliverti

Introduction

In the management of patients with ALI and ARDS, although the notion of ventilator-induced lung injury (VILI) is now well established [1] and the correlation between respiratory system mechanics and outcome have been clearly demonstrated [2, 3], the setting of mechanical ventilation is still based mostly on blood gases rather than assessment of respiratory mechanics.

Several reasons contribute to this anomaly. The limited knowledge of even simple models of respiratory system mechanics and the lack of recognition of the hidden assumptions which are often taken when assessing respiratory mechanics with different models and methods probably represent the most significant causes of the gap existing between research and clinical practice. These limitations include an incomplete awareness of the differences existing between static and dynamical procedures used to assess mechanical properties and between linear and nonlinear models of the respiratory system. In addition, there is still a limited familiarity with several measurements employed for a complete assessment of respiratory mechanics, such as airway opening pressure as an estimation of tracheal pressure and esophageal pressure in the supine position as an estimation of pressure in the pleural space.

This chapter is organized into four sections: (1) modeling of the respiratory mechanics, (2) methods of assessing respiratory mechanics in ARDS patients currently used in clinical practice, (3) methods for assessing active components of the respiratory system in ARDS, and (4) main issues related with measuring the variables necessary for the assessment of respiratory mechanics.

A. Aliverti (*)

Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, P.zza L. da Vinci, 32, 20133 Milan, Italy e-mail: This email address is being protected from spam bots, you need Javascript enabled to view it

© Springer International Publishing Switzerland 2017 D. Chiumello (ed.), Acute Respiratory Distress Syndrome (ARDS), DOI 10.1007/978-3-319-41852-0_14

 
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