Fig. 1
From: High PEEP may have reduced injurious transpulmonary pressure swings in the ROSE trial
Intensity of spontaneous effort with low vs. high positive end-expiratory pressure (PEEP) in an experimental model of severe acute respiratory distress syndrome. a Representative waveforms of airway pressure (PAW), esophageal pressure (PES), and electrical activity of the diaphragm (EAdi). Note that the magnitude of the negative swings of esophageal pressure was reduced by approximately 50% when PEEP was increased from 7 cmH2O (low PEEP/FIO2 table, corresponding to lung collapse = 21%) to 15 cmH2O [PEEP level individually titrated by electrical impedance tomography (EIT), corresponding to lung collapse < 1%], with similar EAdi. b A zoom into the shaded areas that highlight the induced neuromechanical uncoupling when PEEP was increased, that is, less pressure generated by the respiratory muscles (PMUS) for each microvolt of electrical activity (PMUS/EAdi index during low and high PEEP = 1.33 cmH2O/μV vs. 0.6 cmH2O/μV, respectively)