Goal-Directed Mechanical Ventilation: Are We Aiming at the Right Goals? A Proposal for an Alternative Approach Aiming at Optimal Lung Compliance, Guided by Esophageal Pressure in Acute Respiratory Failure
Figure 4
Pressure tracing demonstrating mandatory breaths delivered with inspiratory pressure of 20 cm (breaths number 1 and 3). The second breath is initiated by the patient and is assisted with pressure support of 20 cm by the ventilator. The large inspiratory effort by the patient (breath 2) results in a negative deflection on the esophageal pressure tracing. This negative deflection generates high transpulmonary pressure, in this example close to 30 cm . = airway opening pressure, = esophageal pressure, = transpulmonary pressure.
