Ppl on vent

 Q: The plateau pressure (Pplat or Ppl) on a ventilator is a reflection of static compliance of? (select one)

 A) lung parenchyma 

 B) chest wall

 C) chest wall and abdomen

 D) Lung parenchyma, chest wall and abdomen

Answer: D

The objective of the above question is to emphasize the role of abdominal pressure during ventilation. Excessive focus on the chest/thoracic-cage may keep clinicians away from considering a major role high intraabdominal pressure (IAP) plays in chest mechanics or failed ventilation. Reading Pplat in conjunction with a physical exam, other ventilator parameters, and radiological findings may help in solving this query. 

Unfortunately, there is a dearth of recent literature on this topic, we tried to put some articles together in the reference section.

# ventilators

#pulmonary

References:

1. Richardson JD, Trinkee JK. Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J Surg. 1976;20:401–4.

2. Ridings PC, Bloomfield GL, Blocher GR, Sugerman HJ. Cardiopulmonary effects of raised intra-abdominal pressure before and after intravascular volume expansion. J Trauma. 1995;39:1071–5. 

3. Cullen DJ, Coyle JP, Teplick R, Long MC. Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med. 1989;17:118–21. 

4. Bloomfield GL, Ridings PC, Blocher CR, Marmaru A, Sugerman HJ. A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit Care Med. 1997;25:496–503. 

5. Pelosi P, Cereda M, Foti G, Giacomini M, Pesenti A. Alterations of lung and chest wall mechanics in patients with acute lung injury: effects of positive end-expiratory pressure. Am J Respir Crit Care Med. 1995;152:531–7. 

6.  Malbrain ML, Deeren D, Nieuwendiijk R. Partitioning of respiratory mechanics in intra-abdominal hypertension. Intensive Care Med. 2003;29:S85.

7. Anbar JT, Antunes T, Barbas CSV. Influence of PEEP and external abdominal weight in airway and intra-abdominal pressures in mechanically ventilated ICU patients. Am J Respir Crit Care Med. 2005. p. A665. 

8. Mutoh T, Lamm WJ, Embree LJ, Hildebrandt J, Albert RK. Abdominal distension alters regional pleural pressures and chest wall mechanics in pigs in vivo. J Appl Physiology. 1991;70:2611–8

9. Tobin MJ. Respiratory monitoring. JAMA 1990; 264:244. 

10. Marini, JJ. Lung mechanics determinations at the bedside: instrumentation and clinical applications. Respir Care 1990; 35:669.