{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T23:02:48Z","timestamp":1774911768895,"version":"3.50.1"},"reference-count":41,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[1997,9,1]],"date-time":"1997-09-01T00:00:00Z","timestamp":873072000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1997,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To investigate whether chest-wall mechanics could affect the total respiratory system pressure\u2013volume (P\u2013V) curve in patients with acute respiratory failure (ARF), and particularly the lower inflection point (LIP) of the curve, we drew the total respiratory system, lung, and chest-wall P\u2013V curves (P\u2013Vrs, P\u2013Vl, and P\u2013Vw, respectively) for 13 patients with ARF, using the supersyringe method together with the esophageal balloon technique. Measurements were randomly repeated at four different levels of positive end-expiratory pressure (PEEP) (0, 5, 10, 15 cm H2O) and from each P\u2013V curve we derived starting compliance (Cstart), inflation compliance (Cinf), and end compliance (Cend). With PEEP of 0 cm H2O (ZEEP), an LIP on the P\u2013Vrs curve was observed in all patients (7.5 \u00b1 3.9 cm H2O); in two patients an LIP was detected only on the P\u2013Vl curve (8.6 and 8.7 cm H2O, respectively); whereas in seven patients an LIP was observed only on the P\u2013Vw curve (3.4 \u00b1 1.1 cm H2O). In four patients, an LIP was detected on both the P\u2013Vl and P\u2013Vw curves (8.5 \u00b1 3.4 and 2.2 \u00b1 1.0 cm H2O, respectively). The LIP was abolished by PEEP, suggesting that a volume-related mechanism was responsible for the observed LIP on both the P\u2013Vl and P\u2013Vw curves. At high levels of PEEP, an upper inflection point (UIP) appeared on the P\u2013Vrs and P\u2013Vl curves (11.7 \u00b1 4.9 cm H2O and 8.9 \u00b1 4.2 cm H2O above PEEP, respectively) suggesting alveolar overdistension. In general, PaO2 increased with PEEP (from 81.7 \u00b1 35.5 mm Hg on ZEEP to 120 \u00b1 43.8 mm Hg on PEEP 15 cm H2O, p &amp;lt; 0.002); however, the increase in PaO2 with PEEP was significant only in patients with an LIP on the P\u2013Vl curve (from 70.5 \u00b1 16.2 mm Hg to 117.5 \u00b1 50.7 mm Hg, p &amp;lt; 0.002), the changes in PaO2 in patients without an LIP on the P\u2013Vl curve not being significant (from 91.3 \u00b1 45.4 mm Hg to 122.2 \u00b1 41.1 mm Hg). We conclude that in ventilator-dependent patients with ARF: (1) the chest-wall mechanics can contribute to the LIP observed on the P\u2013Vrs curve; (2) the improvement in PaO2 with PEEP is significant only in patients in whom LIP is on the lung P\u2013V curve and not on the chest wall curve; (3) high levels of PEEP may overdistend the lung, as reflected by the appearance of a UIP; (4) measurement of P\u2013Vrs alone may be misleading as a guide for setting the level of PEEP in some mechanically ventilated patients, at least in the supine position, although it helps to prevent excessive alveolar overdistension by indicating the inflection volume above which UIP may appear.<\/jats:p>","DOI":"10.1164\/ajrccm.156.3.9607040","type":"journal-article","created":{"date-parts":[[2013,4,4]],"date-time":"2013-04-04T13:25:01Z","timestamp":1365081901000},"page":"846-854","source":"Crossref","is-referenced-by-count":122,"title":["Impact of Positive End-expiratory Pressure on Chest Wall and Lung Pressure\u2013Volume Curve in Acute Respiratory Failure"],"prefix":"10.1093","volume":"156","author":[{"given":"MARIO","family":"MERGONI","sequence":"first","affiliation":[{"name":"1\u00b0 Servizio di Anestesia e Rianimazione, Azienda Ospedaliera di Parma, Parma; and Servizio di Fisiopatologia Respiratoria, Azienda Ospedaliera di Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ALESSANDRA","family":"MARTELLI","sequence":"additional","affiliation":[{"name":"1\u00b0 Servizio di Anestesia e Rianimazione, Azienda Ospedaliera di Parma, Parma; and Servizio di Fisiopatologia Respiratoria, Azienda Ospedaliera di Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ANNALISA","family":"VOLPI","sequence":"additional","affiliation":[{"name":"1\u00b0 Servizio di Anestesia e Rianimazione, Azienda Ospedaliera di Parma, Parma; and Servizio di Fisiopatologia Respiratoria, Azienda Ospedaliera di Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"STEFANIA","family":"PRIMAVERA","sequence":"additional","affiliation":[{"name":"1\u00b0 Servizio di Anestesia e Rianimazione, Azienda Ospedaliera di Parma, Parma; and Servizio di Fisiopatologia Respiratoria, Azienda Ospedaliera di Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"PAOLO","family":"ZUCCOLI","sequence":"additional","affiliation":[{"name":"1\u00b0 Servizio di Anestesia e Rianimazione, Azienda Ospedaliera di Parma, Parma; and Servizio di Fisiopatologia Respiratoria, Azienda Ospedaliera di Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ANDREA","family":"ROSSI","sequence":"additional","affiliation":[{"name":"1\u00b0 Servizio di Anestesia e Rianimazione, Azienda Ospedaliera di Parma, Parma; and Servizio di Fisiopatologia Respiratoria, Azienda Ospedaliera di Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1997,9,1]]},"reference":[{"key":"2026032709220782000_B1","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1164\/ajrccm\/138.6.1625","article-title":"State of the art: respiratory monitoring in the intensive care unit.","volume":"138","author":"Tobin","year":"1988","journal-title":"Am. 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