{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:17:00Z","timestamp":1777933020083,"version":"3.51.4"},"reference-count":39,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T00:00:00Z","timestamp":1728345600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Recruitment maneuvers are used in patients with ARDS to enhance oxygenation and lung mechanics. Heterogeneous lung and chest-wall mechanics lead to unpredictable transpulmonary pressures and could impact recruitment maneuver success. Tailoring care based on individualized transpulmonary pressure might optimize recruitment, preventing overdistention. This study aimed to identify the optimal transpulmonary pressure for effective recruitment and to explore its association with baseline characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed post hoc analysis on the Esophageal Pressure Guided Ventilation (EpVent2) trial. We estimated the dose-response relationship between end-recruitment end-inspiratory transpulmonary pressure and the change in lung elastance after a recruitment maneuver by using logistic regression weighted by a generalized propensity score. A positive change in lung elastance was indicative of overdistention. We examined how patient characteristics, disease severity markers, and respiratory parameters predict transpulmonary pressure by using multivariate linear regression models and dominance analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of 121 subjects, 43.8% had a positive change in lung elastance. Subjects with a positive change in lung elastance had a mean \u00b1 SD transpulmonary pressure of 15.1 \u00b1 4.9 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O, compared with 13.9 \u00b1 3.9 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O in those with a negative change in lung elastance. Higher transpulmonary pressure was associated with increased probability of a positive change in lung elastance (adjusted odds ratio 1.35 per 1 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O of transpulmonary pressure, 95% CI 1.13\u20131.61;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .001), which indicated an S-shaped dose-response curve, with overdistention probability &gt; 50% at transpulmonary pressure values &gt; 18.3 cm H\n                      <jats:sub>2<\/jats:sub>\n                      O. The volume of recruitment was transpulmonary pressure\u2013dependent (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001; R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.49) and inversely related to a change in lung elastance after adjusting for baseline lung elastance (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001; R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.43). Negative correlations were observed between transpulmonary pressure and body mass index, PEEP, Sequential Organ Failure Assessment score, and P\n                      <jats:sub>\n                        aO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      \/F\n                      <jats:sub>\n                        IO\n                        <jats:sub>2<\/jats:sub>\n                      <\/jats:sub>\n                      , whereas baseline lung elastance showed a positive correlation. The body mass index emerged as the dominant negative predictor of transpulmonary pressure (ranking 1; contribution to R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.08), whereas pre-recruitment elastance was the sole positive predictor (contribution to R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.06).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Higher end-recruitment transpulmonary pressure increases the volume of recruitment but raises the risk of overdistention, providing the rationale for transpulmonary pressure to be used as a clinical target. Predictors, for example, body mass index, could guide recruitment maneuver individualization to balance adequate volume gain with overdistention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/respcare.11736","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T11:57:23Z","timestamp":1736769443000},"page":"1-9","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Transpulmonary Pressure as a Predictor of Successful Lung Recruitment: Reanalysis of a Multicenter International Randomized Clinical Trial"],"prefix":"10.1177","volume":"70","author":[{"given":"Abeer","family":"Santarisi","sequence":"first","affiliation":[{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Talmor, Goodspeed, and Schaefer are affiliated with the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."},{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Goodspeed, Jung, Schaefer, and Baedorf Kassis are affiliated with the Center for Anesthesia Research Excellence, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."},{"name":"Dr. Santarisi is affiliated with the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aiman","family":"Suleiman","sequence":"additional","affiliation":[{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Talmor, Goodspeed, and Schaefer are affiliated with the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."},{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Goodspeed, Jung, Schaefer, and Baedorf Kassis are affiliated with the Center for Anesthesia Research Excellence, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."},{"name":"Dr. Suleiman is affiliated with the Department of Anesthesia and Intensive Care, Faculty of Medicine, University of Jordan, Amman, Jordan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Redaelli","sequence":"additional","affiliation":[{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Talmor, Goodspeed, and Schaefer are affiliated with the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."},{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Goodspeed, Jung, Schaefer, and Baedorf Kassis are affiliated with the Center for Anesthesia Research Excellence, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."},{"name":"Dr. Redaelli is affiliated with the School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dario","family":"von Wedel","sequence":"additional","affiliation":[{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Talmor, Goodspeed, and Schaefer are affiliated with the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."},{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Goodspeed, Jung, Schaefer, and Baedorf Kassis are affiliated with the Center for Anesthesia Research Excellence, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy R.","family":"Beitler","sequence":"additional","affiliation":[{"name":"Dr. Beitler is affiliated with the Center for Acute Respiratory Failure and Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Talmor","sequence":"additional","affiliation":[{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Talmor, Goodspeed, and Schaefer are affiliated with the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie","family":"Goodspeed","sequence":"additional","affiliation":[{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Talmor, Goodspeed, and Schaefer are affiliated with the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."},{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Goodspeed, Jung, Schaefer, and Baedorf Kassis are affiliated with the Center for Anesthesia Research Excellence, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boris","family":"Jung","sequence":"additional","affiliation":[{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Goodspeed, Jung, Schaefer, and Baedorf Kassis are affiliated with the Center for Anesthesia Research Excellence, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."},{"name":"Dr. Jung is affiliated with the Medical Intensive Care Unit, Montpellier University, Montpellier, France."},{"name":"Drs. Jung and Baedorf Kassis are affiliated with the Department of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian S.","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Talmor, Goodspeed, and Schaefer are affiliated with the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."},{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Goodspeed, Jung, Schaefer, and Baedorf Kassis are affiliated with the Center for Anesthesia Research Excellence, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."},{"name":"Dr. Schaefer is affiliated with Department of Anesthesiology, D\u00fcsseldorf University Hospital, Dusseldorf, Germany."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elias","family":"Baedorf Kassis","sequence":"additional","affiliation":[{"name":"Drs. Santarisi, Suleiman, Redaelli, von Wedel, Goodspeed, Jung, Schaefer, and Baedorf Kassis are affiliated with the Center for Anesthesia Research Excellence, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts."},{"name":"Drs. Jung and Baedorf Kassis are affiliated with the Department of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,10,8]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1208707"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04409"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.08280"},{"issue":"11","key":"e_1_3_4_5_2","first-page":"CD006667","article-title":"Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation","volume":"11","author":"Hodgson C","year":"2016","unstructured":"Hodgson C, , Goligher EC, , Young ME, et al. Recruitment manoeuvres for adults with acute respiratory distress syndrome receiving mechanical ventilation. 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