{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:01:35Z","timestamp":1790686895443,"version":"4.1.0"},"reference-count":59,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2019,7,28]],"date-time":"2019-07-28T00:00:00Z","timestamp":1564272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swedish Council of Research (Vetenskapsr\u00e5det)","award":["K2015-99X-22731-01-4"],"award-info":[{"award-number":["K2015-99X-22731-01-4"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Modern ventilatory strategies are based on the assumption that lung terminal airspaces act as isotropic balloons that progressively accommodate gas. Phase contrast synchrotron radiation computed tomography (PCSRCT) has recently challenged this concept, showing that in healthy lungs, deflation mechanisms are based on the sequential de-recruitment of airspaces. Using PCSRCT scans in an animal model of acute respiratory distress syndrome (ARDS), this study examined whether the numerosity (ASnum) and dimension (ASdim) of lung airspaces change during a deflation maneuver at decreasing levels of positive end-expiratory pressure (PEEP) at 12, 9, 6, 3, and 0 cmH2O. Deflation was associated with significant reduction of ASdim both in the whole lung section (passing from from 13.1 \u00b1 2.0 at PEEP 12 to 7.6 \u00b1 4.2 voxels at PEEP 0) and in single concentric regions of interest (ROIs). However, the regression between applied PEEP and ASnum was significant in the whole slice (ranging from 188 \u00b1 52 at PEEP 12 to 146.4 \u00b1 96.7 at PEEP 0) but not in the single ROIs. This mechanism of deflation in which reduction of ASdim is predominant, differs from the one observed in healthy conditions, suggesting that the peculiar alveolar micromechanics of ARDS might play a role in the deflation process.<\/jats:p>","DOI":"10.3390\/jcm8081117","type":"journal-article","created":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T03:06:58Z","timestamp":1564369618000},"page":"1117","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The Effect of Positive End-Expiratory Pressure on Lung Micromechanics Assessed by Synchrotron Radiation Computed Tomography in an Animal Model of ARDS"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9739-4082","authenticated-orcid":false,"given":"Gaetano","family":"Scaramuzzo","sequence":"first","affiliation":[{"name":"Department of Morphology, Surgery and Experimental Medicine, Ferrara University, 44121 Ferrara, Italy"},{"name":"Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludovic","family":"Broche","sequence":"additional","affiliation":[{"name":"Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela","family":"Pellegrini","sequence":"additional","affiliation":[{"name":"Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden"},{"name":"Department of Anesthesia and Intensive Care, Uppsala University Hospital, 75185 Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3639-944X","authenticated-orcid":false,"given":"Liisa","family":"Porra","sequence":"additional","affiliation":[{"name":"Department of Physics, University of Helsinki, FI-00014 Helsinki, Finland"},{"name":"Helsinki University Hospital, FI-00029 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savino","family":"Derosa","sequence":"additional","affiliation":[{"name":"Department of Emergency and Organ Transplant, Bari University, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela Principia","family":"Tannoia","sequence":"additional","affiliation":[{"name":"Department of Emergency and Organ Transplant, Bari University, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Marzullo","sequence":"additional","affiliation":[{"name":"Department of Emergency and Organ Transplant, Bari University, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Batista","family":"Borges","sequence":"additional","affiliation":[{"name":"Centre for Human and Applied Physiological Sciences, Faculty of Sciences and Medicine, King\u2019s College, London WC2R 2LS, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Bayat","sequence":"additional","affiliation":[{"name":"The European Synchrotron Radiation Facility, 38043 Grenoble, France"},{"name":"INSERM UA7, Synchrotron Radiation for Biomedicine (STROBE) Laboratory, University of Grenoble Alpes, 38043 Grenoble, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6868-2755","authenticated-orcid":false,"given":"Alberto","family":"Bravin","sequence":"additional","affiliation":[{"name":"The European Synchrotron Radiation Facility, 38043 Grenoble, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Larsson","sequence":"additional","affiliation":[{"name":"Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6834-6399","authenticated-orcid":false,"given":"Gaetano","family":"Perchiazzi","sequence":"additional","affiliation":[{"name":"Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, 75185 Uppsala, Sweden"},{"name":"Department of Anesthesia and Intensive Care, Uppsala University Hospital, 75185 Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1001\/jama.2016.0291","article-title":"Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries","volume":"315","author":"Bellani","year":"2016","journal-title":"JAMA"},{"key":"ref_2","unstructured":"ARDS Definition Task Force, Ranieri, V.M., Rubenfeld, G.D., Thompson, B.T., Ferguson, N.D., Caldwell, E., Fan, E., Camporota, L., and Slutsky, A.S. (2012). Acute respiratory distress syndrome: The Berlin definition. JAMA, 307, 2526\u20132533."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1056\/NEJMra1208707","article-title":"Ventilator-induced lung injury","volume":"369","author":"Slutsky","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S0140-6736(67)90168-7","article-title":"Acute respiratory distress in adults","volume":"2","author":"Ashbaugh","year":"1967","journal-title":"Lancet Lond. Engl."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1164\/ajrccm.152.6.8520744","article-title":"Beneficial effects of the \u201copen lung approach\u201d with low distending pressures in acute respiratory distress syndrome. A prospective randomized study on mechanical ventilation","volume":"152","author":"Amato","year":"1995","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1164\/ajrccm.152.1.7599810","article-title":"Titration of tidal volume and induced hypercapnia in acute respiratory distress syndrome","volume":"152","author":"Roupie","year":"1995","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_7","unstructured":"Greaves, I.A., Hildebrandt, J., and Hoppin, F.G. (2011). Micromechanics of the Lung. Comprehensive Physiology, American Cancer Society."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"719","DOI":"10.3389\/fphys.2019.00719","article-title":"Regional behavior of airspaces during positive pressure reduction assessed by synchrotron radiation computed tomography","volume":"10","author":"Scaramuzzo","year":"2019","journal-title":"Front. Physiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1152\/japplphysiol.00439.2010","article-title":"Lung regional stress and strain as a function of posture and ventilatory mode","volume":"110","author":"Perchiazzi","year":"2011","journal-title":"J. Appl. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.resp.2014.07.001","article-title":"Regional distribution of lung compliance by image analysis of computed tomograms","volume":"201","author":"Perchiazzi","year":"2014","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1007\/s10439-010-0214-0","article-title":"Analysis of regional mechanics in canine lung injury using forced oscillations and 3D image registration","volume":"39","author":"Kaczka","year":"2011","journal-title":"Ann. Biomed. Eng."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1097\/01.CCM.0000059997.90832.29","article-title":"Alveolar inflation during generation of a quasi-static pressure\/volume curve in the acutely injured lung","volume":"31","author":"Schiller","year":"2003","journal-title":"Crit. Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/s13054-016-1268-7","article-title":"How ARDS should be treated","volume":"20","author":"Gattinoni","year":"2016","journal-title":"Crit. Care Lond. Engl."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1152\/jappl.1956.8.4.427","article-title":"Mechanical factors in distribution of pulmonary ventilation","volume":"8","author":"Otis","year":"1956","journal-title":"J. Appl. Physiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"R23","DOI":"10.1186\/cc12500","article-title":"Expiratory time constant for determinations of plateau pressure, respiratory system compliance, and total resistance","volume":"17","author":"Banner","year":"2013","journal-title":"Crit. Care Lond. Engl."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1183\/09031936.95.08010114","article-title":"Time constant\/volume relationship of passive expiration in mechanically ventilated ARDS patients","volume":"8","author":"Guttmann","year":"1995","journal-title":"Eur. Respir. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1113\/EP085205","article-title":"Gas density alters expiratory time constants before and after experimental lung injury","volume":"100","author":"Henderson","year":"2015","journal-title":"Exp. Physiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1164\/rccm.200710-1589OC","article-title":"Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome","volume":"178","author":"Chiumello","year":"2008","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1164\/rccm.201308-1567OC","article-title":"Lung inhomogeneity in patients with acute respiratory distress syndrome","volume":"189","author":"Cressoni","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1097\/MCC.0b013e32834f17d9","article-title":"Stress and strain within the lung","volume":"18","author":"Gattinoni","year":"2012","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1152\/jappl.1970.28.5.596","article-title":"Stress distribution in lungs: A model of pulmonary elasticity","volume":"28","author":"Mead","year":"1970","journal-title":"J. Appl. Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.resp.2016.03.005","article-title":"Effects of superimposed tissue weight on regional compliance of injured lungs","volume":"228","author":"Pellegrini","year":"2016","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1146\/annurev.physiol.68.072304.114110","article-title":"Stress transmission in the lung: Pathways from organ to molecule","volume":"68","author":"Fredberg","year":"2006","journal-title":"Annu. Rev. Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1164\/ajrccm.164.9.2103121","article-title":"What has computed tomography taught us about the acute respiratory distress syndrome?","volume":"164","author":"Gattinoni","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1152\/japplphysiol.00768.2011","article-title":"Morphometric changes in the human pulmonary acinus during inflation","volume":"112","author":"Hajari","year":"2012","journal-title":"J. Appl. Physiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"L305","DOI":"10.1152\/ajplung.00048.2017","article-title":"Hyperpolarized gas diffusion MRI of biphasic lung inflation in short- and long-term emphysema models","volume":"313","author":"Xin","year":"2017","journal-title":"Am. J. Physiol. Lung Cell. Mol. Physiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.resp.2014.07.012","article-title":"Alveolar mechanics studied by in vivo microscopy imaging through intact pleural space","volume":"202","author":"Salito","year":"2014","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1164\/ajrccm.160.5.9812031","article-title":"The mechanism of lung volume change during mechanical ventilation","volume":"160","author":"Carney","year":"1999","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"R1","DOI":"10.1088\/0031-9155\/58\/1\/R1","article-title":"X-ray phase-contrast imaging: From pre-clinical applications towards clinics","volume":"58","author":"Bravin","year":"2013","journal-title":"Phys. Med. Biol."},{"key":"ref_30","unstructured":"(2010). Directive 2010\/63\/EU of the European Parliament and of the Council of 22 September 2010 on the Protection of Animals Used for Scientific Purposes. Text with EEA relevance. Off. J. Eur. Union, 276, 33\u201379."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1107\/S0909049500008384","article-title":"Fixed-exit monochromator for computed tomography with synchrotron radiation at energies 18\u201390 keV","volume":"7","author":"Suortti","year":"2000","journal-title":"J. Synchrotron Radiat."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1107\/S0909049506008983","article-title":"Evaluation of imaging performance of a taper optics CCD; FReLoN\u2019 camera designed for medical imaging","volume":"13","author":"Coan","year":"2006","journal-title":"J. Synchrotron Radiat."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Dougherty, E.R., and Lotufo, R.A. (2003). Gray scale morphology. Hands-on Morphological Image Processing, SPIE Optical Engineering Press.","DOI":"10.1117\/3.501104"},{"key":"ref_34","unstructured":"Bonferroni, C.E. (1936). Teoria Statistica Delle Classi e Calcolo Delle Probabilit\u00e0, Libreria Internazionale Seeber."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1164\/ajrccm.163.1.9905084","article-title":"Best compliance during a decremental, but not incremental, positive end-expiratory pressure trial is related to open-lung positive end-expiratory pressure: A mathematical model of acute respiratory distress syndrome lungs","volume":"163","author":"Hickling","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1038\/368615a0","article-title":"Avalanches and power-law behaviour in lung inflation","volume":"368","author":"Suki","year":"1994","journal-title":"Nature"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1152\/jappl.1970.29.4.422","article-title":"Pressure-volume curves of air- and liquid-filled excised lungs-surface tension in situ","volume":"29","author":"Bachofen","year":"1970","journal-title":"J. Appl. Physiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1164\/rccm.200312-1644OC","article-title":"Tomographic study of the inflection points of the pressure-volume curve in acute lung injury","volume":"170","author":"Albaiceta","year":"2004","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1186\/s13054-019-2417-6","article-title":"Heterogeneity of regional inflection points from pressure-volume curves assessed by electrical impedance tomography","volume":"23","author":"Scaramuzzo","year":"2019","journal-title":"Crit. Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1152\/japplphysiol.90735.2008","article-title":"The role of time and pressure on alveolar recruitment","volume":"106","author":"Albert","year":"2009","journal-title":"J. Appl. Physiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1152\/jappl.1993.75.3.1323","article-title":"Role of pulmonary surfactant in airway closure: A computational study","volume":"75","author":"Otis","year":"1993","journal-title":"J. Appl. Physiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1007\/s10439-007-9291-0","article-title":"A recruitment model of quasi-linear power-law stress adaptation in lung tissue","volume":"35","author":"Bates","year":"2007","journal-title":"Ann. Biomed. Eng."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1152\/jappl.1990.69.1.74","article-title":"Effects of surface tension and viscosity on airway reopening","volume":"69","author":"Gaver","year":"1990","journal-title":"J. Appl. Physiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1097\/CCM.0000000000002234","article-title":"Dynamic Mechanical Interactions Between Neighboring Airspaces Determine Cyclic Opening and Closure in Injured Lung","volume":"45","author":"Broche","year":"2017","journal-title":"Crit. Care Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1152\/jappl.1979.47.5.990","article-title":"Alveolar volume-surface area relation in air- and saline-filled lungs fixed by vascular perfusion","volume":"47","author":"Gil","year":"1979","journal-title":"J. Appl. Physiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"L625","DOI":"10.1152\/ajplung.00105.2011","article-title":"What do we know about mechanical strain in lung alveoli?","volume":"301","author":"Roan","year":"2011","journal-title":"Am. J. Physiol. Lung Cell. Mol. Physiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/0034-5687(74)90078-4","article-title":"Lung volume, thickness of alveolar walls, and microscopic anisotropy of expansion","volume":"22","author":"Tsunoda","year":"1974","journal-title":"Respir. Physiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2731","DOI":"10.1172\/JCI60331","article-title":"The acute respiratory distress syndrome","volume":"122","author":"Matthay","year":"2012","journal-title":"J. Clin. Investig."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Broche, L., Pisa, P., Porra, L., Degrugilliers, L., Bravin, A., Pellegrini, M., Borges, J.B., Perchiazzi, G., Larsson, A., and Hedenstierna, G. (2019). Individual airway closure characterized in vivo by phase-contrast CT imaging in injured rabbit lung. Crit. Care Med., Epub ahead of print.","DOI":"10.1097\/CCM.0000000000003838"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/0034-5687(72)90032-1","article-title":"Local alveolar size and transpulmonary pressure in situ and in isolated lungs","volume":"14","year":"1972","journal-title":"Respir. Physiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1038\/197054a0","article-title":"Comparative quantitative morphology of the mammalian lung: Diffusing area","volume":"197","author":"Tenney","year":"1963","journal-title":"Nature"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/00000542-199101000-00004","article-title":"Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure","volume":"74","author":"Gattinoni","year":"1991","journal-title":"Anesthesiology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1164\/ajrccm.149.1.8111603","article-title":"Vertical gradient of regional lung inflation in adult respiratory distress syndrome","volume":"149","author":"Pelosi","year":"1994","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1152\/jappl.1983.55.4.1321","article-title":"Role of alveolar recruitment in lung inflation: Influence on pressure-volume hysteresis","volume":"55","author":"Smaldone","year":"1983","journal-title":"J. Appl. Physiol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"151","DOI":"10.2307\/2982800","article-title":"The Non-Orthogonal Design of Experiments","volume":"153","author":"Mead","year":"1990","journal-title":"J. R. Stat. Soc. Ser. A Stat. Soc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e279","DOI":"10.1097\/CCM.0000000000000161","article-title":"Early inflammation mainly affects normally and poorly aerated lung in experimental ventilator-induced lung injury","volume":"42","author":"Borges","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/MCC.0000000000000043","article-title":"Epithelial and endothelial damage induced by mechanical ventilation modes","volume":"20","author":"Suki","year":"2014","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1183\/09031936.97.10010192","article-title":"Additive nature of distension and surfactant perturbation on alveolocapillary permeability","volume":"10","author":"John","year":"1997","journal-title":"Eur. Respir. J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1056\/NEJMoa032193","article-title":"Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome","volume":"351","author":"Brower","year":"2004","journal-title":"N. Engl. J. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/8\/1117\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:10:33Z","timestamp":1760188233000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/8\/1117"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,28]]},"references-count":59,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,8]]}},"alternative-id":["jcm8081117"],"URL":"https:\/\/doi.org\/10.3390\/jcm8081117","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,28]]}}}