Physiological Consequences of Breathing Effort According to the Mode of Ventilation during Acute Hypoxemic Respiratory Failure
Issued Date
2026-03-01
Resource Type
eISSN
15354970
Scopus ID
2-s2.0-105038297350
Pubmed ID
40700741
Journal Title
American Journal of Respiratory and Critical Care Medicine
Volume
212
Issue
3
Start Page
487
End Page
499
Rights Holder(s)
SCOPUS
Bibliographic Citation
American Journal of Respiratory and Critical Care Medicine Vol.212 No.3 (2026) , 487-499
Suggested Citation
Telias I., Madorno M., Pham T., Coudroy R., Mellado Artigas R., Baedorf-Kassis E., Chen C.W., Spadaro S., Chiumello D., Beitler J., Kondili E., Tiribelli N., Fredes S., Becher T., Dres M., Liu K., Terzi N., Guérin C., Mauri T., Roca O., Mancebo J., Rodriguez N., Arnal J.M., Goligher E.C., Diehl J.L., Jochmans S., Beloncle F., Rittayamai N., Mojoli F., Heunks L., de Vries H., Zhou J.X., Guervilly C., Brochard L. Physiological Consequences of Breathing Effort According to the Mode of Ventilation during Acute Hypoxemic Respiratory Failure. American Journal of Respiratory and Critical Care Medicine Vol.212 No.3 (2026) , 487-499. 499. doi:10.1164/rccm.202411-2155OC Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116734
Title
Physiological Consequences of Breathing Effort According to the Mode of Ventilation during Acute Hypoxemic Respiratory Failure
Author(s)
Telias I.
Madorno M.
Pham T.
Coudroy R.
Mellado Artigas R.
Baedorf-Kassis E.
Chen C.W.
Spadaro S.
Chiumello D.
Beitler J.
Kondili E.
Tiribelli N.
Fredes S.
Becher T.
Dres M.
Liu K.
Terzi N.
Guérin C.
Mauri T.
Roca O.
Mancebo J.
Rodriguez N.
Arnal J.M.
Goligher E.C.
Diehl J.L.
Jochmans S.
Beloncle F.
Rittayamai N.
Mojoli F.
Heunks L.
de Vries H.
Zhou J.X.
Guervilly C.
Brochard L.
Madorno M.
Pham T.
Coudroy R.
Mellado Artigas R.
Baedorf-Kassis E.
Chen C.W.
Spadaro S.
Chiumello D.
Beitler J.
Kondili E.
Tiribelli N.
Fredes S.
Becher T.
Dres M.
Liu K.
Terzi N.
Guérin C.
Mauri T.
Roca O.
Mancebo J.
Rodriguez N.
Arnal J.M.
Goligher E.C.
Diehl J.L.
Jochmans S.
Beloncle F.
Rittayamai N.
Mojoli F.
Heunks L.
de Vries H.
Zhou J.X.
Guervilly C.
Brochard L.
Author's Affiliation
Harvard Medical School
Université Paris-Saclay
Université Paris Cité
Università degli Studi di Milano
University of Toronto Faculty of Medicine
Universitat Autònoma de Barcelona
AP-HP Assistance Publique - Hopitaux de Paris
Amsterdam UMC - University of Amsterdam
Radboud University Medical Center
Università degli Studi di Pavia
NYU Grossman School of Medicine
Université de Lyon
Hôpital Universitaire Pitié Salpêtrière
Hospital Clínic de Barcelona
University Health Network
University of Ferrara
Université de Versailles Saint-Quentin-en-Yvelines
Institut d'Investigacions Biomèdiques August Pi i Sunyer - IDIBAPS
Université de Poitiers
Universitätsklinikum Schleswig-Holstein Campus Kiel
Fondazione IRCCS Policlinico San Matteo
Hospital de La Santa Creu I Sant Pau
Centre Hospitalier Universitaire de Grenoble
Hopital Edouard Herriot
Siriraj Hospital
Beijing Tiantan Hospital, Capital Medical University
CHU Angers
National Cheng Kung University Hospital
Institute of Health Policy, Management and Evaluation
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
Centre Hospitalier Universitaire de Poitiers
Hôpital Nord AP-HM
Ospedale San Paolo
Heraklion University Hospital
Keenan Research Centre for Biomedical Science
Toronto General Hospital Research Institute
Hospital de Sabadell
Laboratoire Hypoxie et Physiopathologies Cardiovasculaires et Respiratoires
Neurophysiologie Respiratoire Expérimentale et Clinique
Instituto Tecnológico de Buenos Aires (ITBA)
Sanatorio de la Trinidad
Churruca Visca Hospital
Hôpital Sainte Musse
Amsterdam Cardiovascular Science Research Institute
Service de Réanimation Médicale
Interdepartmental Division of Critical Care Medicine
Université Paris-Saclay
Université Paris Cité
Università degli Studi di Milano
University of Toronto Faculty of Medicine
Universitat Autònoma de Barcelona
AP-HP Assistance Publique - Hopitaux de Paris
Amsterdam UMC - University of Amsterdam
Radboud University Medical Center
Università degli Studi di Pavia
NYU Grossman School of Medicine
Université de Lyon
Hôpital Universitaire Pitié Salpêtrière
Hospital Clínic de Barcelona
University Health Network
University of Ferrara
Université de Versailles Saint-Quentin-en-Yvelines
Institut d'Investigacions Biomèdiques August Pi i Sunyer - IDIBAPS
Université de Poitiers
Universitätsklinikum Schleswig-Holstein Campus Kiel
Fondazione IRCCS Policlinico San Matteo
Hospital de La Santa Creu I Sant Pau
Centre Hospitalier Universitaire de Grenoble
Hopital Edouard Herriot
Siriraj Hospital
Beijing Tiantan Hospital, Capital Medical University
CHU Angers
National Cheng Kung University Hospital
Institute of Health Policy, Management and Evaluation
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
Centre Hospitalier Universitaire de Poitiers
Hôpital Nord AP-HM
Ospedale San Paolo
Heraklion University Hospital
Keenan Research Centre for Biomedical Science
Toronto General Hospital Research Institute
Hospital de Sabadell
Laboratoire Hypoxie et Physiopathologies Cardiovasculaires et Respiratoires
Neurophysiologie Respiratoire Expérimentale et Clinique
Instituto Tecnológico de Buenos Aires (ITBA)
Sanatorio de la Trinidad
Churruca Visca Hospital
Hôpital Sainte Musse
Amsterdam Cardiovascular Science Research Institute
Service de Réanimation Médicale
Interdepartmental Division of Critical Care Medicine
Corresponding Author(s)
Other Contributor(s)
Abstract
RATIONALE: Excessive stress (distending pressure), strain (volume deformation), and drop in inspiratory alveolar pressure are proposed mechanisms for patient self-inflicted lung injury. OBJECTIVES: To dissect the influence of inspiratory effort, respiratory mechanics, and ventilation mode on lung stress, strain, and drop in inspiratory alveolar pressure and to explore their impact on oxygenation and lung compliance. METHODS: An international cohort study was conducted analyzing respiratory recordings (esophageal pressure) from patients with acute hypoxemic respiratory failure. Association between muscular pressure (Pmus), surrogates of stress (driving transalveolar pressure), strain (Vt), and inspiratory alveolar pressure relative to positive end-expiratory pressure (PEEP) were explored using mixed models, including interactions for ventilation mode, respiratory system elastance, and synchrony. Association between these and changes in oxygenation and lung compliance were explored. MEASUREMENTS AND MAIN RESULTS: Sixty patients from 15 centers represented 528 recordings (339,796 breaths). For each 1 cm H2O increase in Pmus, there were increases in driving transalveolar pressure (median [95% confidence interval (CI)], 0.28 [0.27 to 0.29] cm H2O) and Vt (median [95% CI], 0.16 [0.16 to 0.17] ml/kg of predicted body weight) and a decrease in alveolar pressure (median [95% CI], 0.25 [0.24 to 0.6] cm H2O; P < 0.001). Volume-control ventilation showed lesser increases in stress and strain surrogates than pressure-targeted modes but more drop in alveolar pressure (P < 0.001; Pmus-by-mode interaction). Breath stacking was infrequent and was associated with higher stress. Lower inspiratory alveolar pressure relative to PEEP was associated with subsequent worsening oxygenation (P = 0.04) and higher stress with worsening lung compliance (P = 0.023). CONCLUSIONS: Strong efforts are associated with high surrogates for lung stress, strain, and lower inspiratory alveolar pressure relative to PEEP, differently according to the mode of ventilation, and are associated with subsequent worsening oxygenation and lung compliance.