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Fig. 1 | Critical Care

Fig. 1

From: Potential protective effects of continuous anterior chest compression in the acute respiratory distress syndrome: physiology of an illustrative case

Fig. 1

Effect of continuous anterior chest compression on respiratory mechanics and lung aeration. The patient was ventilated in assist control ventilation with a tidal volume of 350 ml in three different conditions: PEEP 6: with a PEEP level of 6 cm H2O; ZEEP: with zero end expiratory pressure; PEEP 6 + CACC: with a PEEP level of 6 cm H2O and a concomitant continuous anterior chest compression by the mean of a positive pressure of 80 cm H2O applied on the anterior chest wall. Paw: airway pressure waveform; ΔEELV: variation of end expiratory lung volume as compared to the “PEEP 6” condition; Pplat: plateau pressure; ΔP: driving pressure defined as the difference between plateau pressure and total PEEP; CRS: respiratory system compliance; Clung: lung compliance; PLend-insp: transpulmonary pressure at end inspiration, computed as follows: PLend-insp = Pplat x (EL/Ers) where EL is the lung elastance and Ers the respiratory system elastance [5]; PLend-exp: transpulmonary pressure at end expiration, computed as follows: PLend-exp = PEEPt – PESend-exp where PEEPt is the total PEEP and PESend-exp is the end expiratory esophageal pressure value; the chest CT-scan retrieved posterior consolidations with diffuse ground glass opacities, reticulations, and traction bronchiectasis suggestive of a fibrotic evolution; EIT: electrical impedance tomography (Enlight 1800, Timpel, Sao Paulo, Brazil); A/P: percentage of variation in impedance during ventilation (ΔZ) in the anterior (A) and posterior (P) half of the lung; R/L: percentage of variation in impedance during ventilation (ΔZ) in the right (R) and left (L) half of the lung; Clung-ant: regional lung compliance in the anterior (ventral) half of the lung; Clung-post: regional lung compliance in the posterior (dorsal) half of the lung

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