Alveolar Tipping Points in Changing Lungs Related to Positive End-expiratory Pressure

Editorial| December 2023 Alveolar Tipping Points in Changing Lungs Related to Positive End-expiratory Pressure Tilo Winkler, Ph.D.; Tilo Winkler, Ph.D. 1Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. https://orcid.org/0000-0002-7276-5550 Search for other works by this author on: This Site PubMed Google Scholar Marcelo B. P. Amato, M.D., Ph.D. Marcelo B. P. Amato, M.D., Ph.D. 2INCOR - Heart Institute, Cardiopulmonary Department, Pulmonary Division, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil. https://orcid.org/0000-0003-3525-8282 Search for other works by this author on: This Site PubMed Google Scholar Author and Article Information This editorial accompanies the article on p. 801. Accepted for publication September 12, 2023. Address correspondence to Dr. Winkler: Anesthesiology December 2023, Vol. 139, 719–721. https://doi.org/10.1097/ALN.0000000000004777 Connected Content Article: Recruitment-to-inflation Ratio Assessed through Sequential End-expiratory Lung Volume Measurement in Acute Respiratory Distress Syndrome Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Tilo Winkler, Marcelo B. P. Amato; Alveolar Tipping Points in Changing Lungs Related to Positive End-expiratory Pressure. Anesthesiology 2023; 139:719–721 doi: https://doi.org/10.1097/ALN.0000000000004777 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsAnesthesiology Search Advanced Search Topics: lung, positive end-expiratory pressure The fundamental principles of respiratory physiology and lung behavior during mechanical ventilation are well established. However, the effects of lung injury on respiratory structure and function leading to significant heterogeneity among different regions of the lungs are still only partially understood. Even more challenging are state changes, such as regions of the lungs switching from being ventilated to collapsed. Remarkably, these state changes of atelectatic regions involve critical pressures for opening and closing, similar to tipping points (fig. 1A) in other complex systems, e.g., tipping points in asthma leading to “catastrophic” regional airway constriction and ventilation defects.1,2 Additionally, it is a significant challenge to characterize these tipping points.3 Grieco et al.4 show now in a study tracking the end- expiratory lung volume and lung mechanics during decremental positive end-expiratory pressure (PEEP) trials in moderate-to-severe COVID-19 acute respiratory distress syndrome that the degree... You do not currently have access to this content.