{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T10:52:11Z","timestamp":1792234331545,"version":"4.4.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T00:00:00Z","timestamp":1619827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>The physiological basis of lung protection and the impact of positive end-expiratory pressure (PEEP) during pronation in acute respiratory distress syndrome are not fully elucidated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare pleural pressure (Ppl) gradient, ventilation distribution, and regional compliance between dependent and nondependent lungs, and investigate the effect of PEEP during supination and pronation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used a two-hit model of lung injury (saline lavage and high-volume ventilation) in 14 mechanically ventilated pigs and studied supine and prone positions. Global and regional lung mechanics including Ppl and distribution of ventilation (electrical impedance tomography) were analyzed across PEEP steps from 20 to 3 cm H2O. Two pigs underwent computed tomography scans: tidal recruitment and hyperinflation were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>Pronation improved oxygenation, increased Ppl, thus decreasing transpulmonary pressure for any PEEP, and reduced the dorsal\u2013ventral pleural pressure gradient at PEEP\u2009&amp;lt;\u200910 cm H2O. The distribution of ventilation was homogenized between dependent and nondependent while prone and was less dependent on the PEEP level than while supine. The highest regional compliance was achieved at different PEEP levels in dependent and nondependent regions in supine position (15 and 8 cm H2O), but for similar values in prone position (13 and 12 cm H2O). Tidal recruitment was more evenly distributed (dependent and nondependent), hyperinflation lower, and lungs cephalocaudally longer in the prone position.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this lung injury model, pronation reduces the vertical pleural pressure gradient and homogenizes regional ventilation and compliance between the dependent and nondependent regions. Homogenization is much less dependent on the PEEP level in prone than in supine positon.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202007-2957oc","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T16:01:33Z","timestamp":1609948893000},"page":"1266-1274","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":79,"title":["Positive End-Expiratory Pressure, Pleural Pressure, and Regional Compliance during Pronation. An Experimental Study"],"prefix":"10.1093","volume":"203","author":[{"given":"Bhushan H.","family":"Katira","sequence":"first","affiliation":[{"name":"Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"The Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children\u2019s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"The Institute of Medical Science"},{"name":"Department of Physiology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Osada","sequence":"additional","affiliation":[{"name":"Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Interdepartmental Division of Critical Care Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doreen","family":"Engelberts","sequence":"additional","affiliation":[{"name":"Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Bastia","sequence":"additional","affiliation":[{"name":"Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. Felipe","family":"Damiani","sequence":"additional","affiliation":[{"name":"Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Departamento Ciencias de la Salud, Carrera de Kinesiolog\u00eda, Facultad de Medicina, Pontificia Universidad Cat\u00f3lica de Chile, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuehan","family":"Li","sequence":"additional","affiliation":[{"name":"Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Department of Anesthesiology and"},{"name":"Laboratory of Anesthesia and Intensive Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han","family":"Chen","sequence":"additional","affiliation":[{"name":"Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Surgical Intensive Care Unit, Fujian Provincial Hospital, Fuzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"The Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo B. P.","family":"Amato","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Pneumologia LIM-09, Disciplina de Pneumologia, Instituto do Cora\u00e7\u00e3o (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":"Niall D.","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine"},{"name":"Department of Physiology"},{"name":"Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada"},{"name":"Department of Medicine"},{"name":"Institute for Health Policy, Management, and Evaluation"},{"name":"Toronto General Hospital Research Institute, Toronto, Ontario, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Post","sequence":"additional","affiliation":[{"name":"Translational Medicine 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