{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T09:18:51Z","timestamp":1793438331870,"version":"4.5.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Funda\u00e7\u00e3o de Amparo e Pesquisa do Estado de S\u00e3o Paulo"},{"DOI":"10.13039\/501100004809","name":"Financiadora de Estudos e Projetos","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo e Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001807","name":"Financiadora de Estudos e Projetos","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Hypoxemia during mechanical ventilation might be worsened by expiratory muscle activity, which reduces end-expiratory lung volume through lung collapse. A proposed mechanism of benefit of neuromuscular blockade in acute respiratory distress syndrome (ARDS) is the abolition of expiratory efforts. This may contribute to the restoration of lung volumes. The prevalence of this phenomenon, however, is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the incidence and amount of end-expiratory lung impedance (EELI) increase after the administration of neuromuscular blocking agents (NMBAs), clinical factors associated with this phenomenon, its impact on regional lung ventilation, and any association with changes in pleural pressure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included mechanically ventilated patients with ARDS monitored with electrical impedance tomography (EIT) who received NMBAs in one of two centers. We measured changes in EELI, a surrogate for end-expiratory lung volume, before and after NMBA administration. In an additional 10 patients, we investigated the characteristic signatures of expiratory muscle activity depicted by EIT and esophageal catheters simultaneously. Clinical factors associated with EELI changes were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>We included 46 patients, half of whom showed an increase in EELI of &amp;gt;10% of the corresponding Vt (46.2%; IQR, 23.9\u201360.9%). The degree of EELI increase correlated positively with fentanyl dosage and negatively with changes in end-expiratory pleural pressures. This suggests that expiratory muscle activity might exert strong counter-effects against positive end-expiratory pressure that are possibly aggravated by fentanyl.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Administration of NMBAs during EIT monitoring revealed activity of expiratory muscles in half of patients with ARDS. The resultant increase in EELI had a dose\u2013response relationship with fentanyl dosage. This suggests a potential side effect of fentanyl during protective ventilation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202308-1376oc","type":"journal-article","created":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T17:01:58Z","timestamp":1704733318000},"page":"563-572","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":50,"title":["Expiratory Muscle Activity Counteracts Positive End-Expiratory Pressure and Is Associated with Fentanyl Dose in Patients with Acute Respiratory Distress Syndrome"],"prefix":"10.1093","volume":"209","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0568-0124","authenticated-orcid":false,"given":"Glauco M.","family":"Plens","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 Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4014-0863","authenticated-orcid":false,"given":"Maddalena T.","family":"Droghi","sequence":"additional","affiliation":[{"name":"Department of Emergency and Intensive Care, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0727-1132","authenticated-orcid":false,"given":"Glasiele C.","family":"Alcala","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 Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3790-7506","authenticated-orcid":false,"given":"S\u00e9rgio M.","family":"Pereira","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8320-0822","authenticated-orcid":false,"given":"Iuri C.","family":"Wawrzeniak","sequence":"additional","affiliation":[{"name":"Programa de P\u00f3s-Gradua\u00e7\u00e3o em Ci\u00eancias M\u00e9dicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil"},{"name":"Intensive Care Unit, Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4676-7437","authenticated-orcid":false,"given":"Josu\u00e9 A.","family":"Victorino","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre, Brazil"},{"name":"Internal Medicine Department, Universidade Federal de Ci\u00eancias da Sa\u00fade de Porto Alegre, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3592-3444","authenticated-orcid":false,"given":"Chiara","family":"Crivellari","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4379-3808","authenticated-orcid":false,"given":"Alice","family":"Grassi","sequence":"additional","affiliation":[{"name":"School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4506-7212","authenticated-orcid":false,"given":"Emanuele","family":"Rezoagli","sequence":"additional","affiliation":[{"name":"Department of Emergency and Intensive Care, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy"},{"name":"School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8698-2046","authenticated-orcid":false,"given":"Giuseppe","family":"Foti","sequence":"additional","affiliation":[{"name":"Department of Emergency and Intensive Care, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy"},{"name":"School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6941-3626","authenticated-orcid":false,"given":"Eduardo L. 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