Journal Club: Change in plateau from peak pressure during inspiratory holds to identify effort and elastic workload

Author: Maritza Henriques, Reviewer: Munir Karjaghli

Applying the optimal level of assistance is one of the major challenges in mechanical ventilation.

Too much support leads to low effort and may result in diaphragm atrophy, while too little support leads to high effort and greater stress and strain. It is essential to find a balance between lung protection and diaphragm protection, to reduce the risk of VILI, P-SILI and VIDD. A recent multicenter study from Japan, the USA, and Italy, investigated whether the measurement of airway pressure during inspiratory holds could be used in spontaneous patients to estimate the degree of effort and elastic work, and thereby serve as a bedside tool to avoid injurious effort.  In this video, we take a closer look at the results and limitation of this study, as well as the clinical relevance and application of the main findings. Click on the image to watch the video.


Kyogoku M, Shimatani T, Hotz JC, et al. Direction and Magnitude of Change in Plateau From Peak Pressure During Inspiratory Holds Can Identify the Degree of Spontaneous Effort and Elastic Workload in Ventilated Patients. Crit Care Med. 2021 Mar 1;49(3):517-526. 

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Date of Printing: 30.06.2022
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Date of Printing: 30.06.2022
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