{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T18:28:24Z","timestamp":1787077704552,"version":"build-2736575974"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Canadian Institutes of Health Research (CIHR) Fellowship","award":["#187900"],"award-info":[{"award-number":["#187900"]}]},{"name":"The Keenan Chair in Critical Care and Acute Respiratory Failure"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n In patients with acute hypoxemic respiratory failure (AHRF) under mechanical ventilation, the change in pressure slope during a low-flow insufflation indicates a global airway opening pressure (AOP) needed to reopen closed airways and may be used for titration of positive end-expiratory pressure.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To understand 1) if airways open homogeneously inside the lungs or significant regional AOP variations exist; 2) whether the pattern of the pressure slope change during low-flow insufflation can indicate the presence of\u00a0regional AOP variations.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Using electrical impedance tomography, we recorded low-flow insufflation maneuvers (<\u200910 L\/min) starting from end-expiratory positive pressure 0\u20135 cmH\n 2<\/jats:sub>\n O. We measured global (AOP\n global<\/jats:sub>\n ) and regional AOPs from pressure-impedance curves in the four different lung quadrants, and compared AOP\n global<\/jats:sub>\n with the highest quadrantal AOP (AOP\n highest<\/jats:sub>\n ). We categorized the slope change of the low-flow inflation pressure\u2013time curve into three patterns: no change, progressive change, abrupt change.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 36 patients analyzed, 9 (25%) had AOP\n global<\/jats:sub>\n \u2009\u2265\u20095 cmH\n 2<\/jats:sub>\n O whereas 19 (53%) exhibited regional AOP\n highest<\/jats:sub>\n \u2009\u2265\u20095 cmH\n 2<\/jats:sub>\n O. AOP\n global<\/jats:sub>\n was on average similar to AOP of the upper right quadrant (\n P<\/jats:italic>\n \u2009=\u20090.182) but was lower than AOPs of the other three quadrants (\n P<\/jats:italic>\n \u2009<\u20090.01 of each). AOP\n global<\/jats:sub>\n was significantly lower than AOP\n highest<\/jats:sub>\n : 3.0 [2.0\u20134.3]\n vs.<\/jats:italic>\n 5.0 [2.8\u20138.3] cmH\n 2<\/jats:sub>\n O,\n P<\/jats:italic>\n \u2009<\u20090.001. AOP was higher in the dependent than the non-dependent ventilated lung (4.0 [2.0\u20136.3]\n vs<\/jats:italic>\n . 3.0 [2.0\u20135.0] cmH\n 2<\/jats:sub>\n O,\n P<\/jats:italic>\n \u2009<\u20090.001). Seventeen (47%) patients exhibited a \u2018progressive change\u2019 pattern in the pressure\u2013time curve. These patients had a larger difference between AOP\n highest<\/jats:sub>\n and AOP\n global<\/jats:sub>\n (3.0 [2.0\u20134.0] cmH\n 2<\/jats:sub>\n O with a maximum of 8 cmH\n 2<\/jats:sub>\n O) compared to the other two patterns: 1.0 [0\u20131.0] cmH\n 2<\/jats:sub>\n O in \u2018no change\u2019 ,\n P<\/jats:italic>\n \u2009<\u20090.001 and 1.0 [0\u20132.0] cmH\n 2<\/jats:sub>\n O in \u2018abrupt change\u2019 ,\n P<\/jats:italic>\n \u2009=\u20090.003.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n AOP\n global<\/jats:sub>\n mostly reflects the lowest opening pressure in the lung\u00a0and frequently underestimates the highest regional AOP in mechanically ventilated patients with AHRF. A progressive slope change during the low-flow pressure\u2013time curve indicates the presence of several and higher regional AOPs.\n <\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n Clinicaltrials.gov, NCT 05825534 (registered, April 24th, 2023), retrospectively registered.<\/jats:p>\n <\/jats:sec>\n \n Graphical abstract<\/jats:title>\n <\/jats:sec>","DOI":"10.1186\/s13054-025-05264-3","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T07:43:08Z","timestamp":1737013388000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Distribution of airway pressure opening in the lungs measured with electrical impedance tomography (POET): a prospective physiological study"],"prefix":"10.1186","volume":"29","author":[{"given":"Nannan","family":"Sun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clement","family":"Brault","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antenor","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Vieira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vorakamol","family":"Phoophiboon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Slama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Brochard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"5264_CR1","doi-asserted-by":"publisher","first-page":"815601","DOI":"10.3389\/fphys.2021.815601","volume":"12","author":"C Guerin","year":"2021","unstructured":"Guerin C, Cour M, Argaud L. 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Clinical trial registered with clinicaltrials.gov (NCT05825534, April 24th, 2023; retrospectively registered).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"28"}}