{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T09:18:49Z","timestamp":1793438329796,"version":"4.5.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2013,12,1]],"date-time":"2013-12-01T00:00:00Z","timestamp":1385856000000},"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":[[2013,12,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>In normal lungs, local changes in pleural pressure (Ppl) are generalized over the whole pleural surface. However, in a patient with injured lungs, we observed (using electrical impedance tomography) a pendelluft phenomenon (movement of air within the lung from nondependent to dependent regions without change in tidal volume) that was caused by spontaneous breathing during mechanical ventilation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To test the hypotheses that in injured lungs negative Ppl generated by diaphragm contraction has localized effects (in dependent regions) that are not uniformly transmitted, and that such localized changes in Ppl cause pendelluft.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used electrical impedance tomography and dynamic computed tomography (CT) to analyze regional inflation in anesthetized pigs with lung injury. Changes in local Ppl were measured in nondependent versus dependent regions using intrabronchial balloon catheters. The airway pressure needed to achieve comparable dependent lung inflation during paralysis versus spontaneous breathing was estimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>In all animals, spontaneous breathing caused pendelluft during early inflation, which was associated with more negative local Ppl in dependent regions versus nondependent regions (\u221213.0 \u00b1 4.0 vs. \u22126.4 \u00b1 3.8 cm H2O; P &amp;lt; 0.05). Dynamic CT confirmed pendelluft, which occurred despite limitation of tidal volume to less than 6 ml\/kg. Comparable inflation of dependent lung during paralysis required almost threefold greater driving pressure (and tidal volume) versus spontaneous breathing (28.0 \u00b1 0.5 vs. 10.3 \u00b1 0.6 cm H2O, P &amp;lt; 0.01; 14.8 \u00b1 4.6 vs. 5.8 \u00b1 1.6 ml\/kg, P &amp;lt; 0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Spontaneous breathing effort during mechanical ventilation causes unsuspected overstretch of dependent lung during early inflation (associated with reciprocal deflation of nondependent lung). Even when not increasing tidal volume, strong spontaneous effort may potentially enhance lung damage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201303-0539oc","type":"journal-article","created":{"date-parts":[[2013,11,7]],"date-time":"2013-11-07T16:11:05Z","timestamp":1383840665000},"page":"1420-1427","source":"Crossref","is-referenced-by-count":512,"title":["Spontaneous Effort Causes Occult Pendelluft during Mechanical Ventilation"],"prefix":"10.1093","volume":"188","author":[{"given":"Takeshi","family":"Yoshida","sequence":"first","affiliation":[{"name":"Laborat\u00f3rio de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (Incor) Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinicius","family":"Torsani","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (Incor) Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susimeire","family":"Gomes","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (Incor) Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta R.","family":"De Santis","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (Incor) Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo A.","family":"Beraldo","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (Incor) Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo L. V.","family":"Costa","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (Incor) Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro R.","family":"Tucci","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Pneumologia LIM-09, Disciplina de Pneumologia, Heart Institute (Incor) Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter A.","family":"Zin","sequence":"additional","affiliation":[{"name":"Instituto de Biof\u00edsica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P.","family":"Kavanagh","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine and"},{"name":"Department of Anesthesia, Hospital for Sick Children, University of Toronto, Toronto, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo B. 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