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Physical manoeuvres in patients with ARDS and low compliance: bedside approaches to detect lung hyperinflation and optimise mechanical ventilation
Sabtu, 27 Mei 2023 14:34:45

Emanuele Rezoagli, Luca Bastia, Laurent Brochard, Giacomo Bellani

European Respiratory Journal 2023 61: 2202169; DOI: 10.1183/13993003.02169-2022


Mechanical ventilation in acute respiratory distress syndrome (ARDS) aims at delivering protective tidal volume within lungs that are characterised both by collapsed and hyperinflated tissue, and gravity plays a key role in the distribution of aeration [1]. Therefore, mechanical factors exterior to the lungs influence ventilation–perfusion relationships. For instance, prone positioning affects lung and chest wall geometry leading to beneficial physiological changes [2], whereas chest wall restriction is known to decrease lung resting volume [3]; applying negative pressure on the abdomen may generate a regional reopening of the lung [4]. Furthermore, sequential lateral positioning has been recently proposed as a potential manoeuvre to redistribute lung resting volume and promote alveolar recruitment [5].

Chest wall compression may detect lung hyperinflation at the bedside in patients undergoing mechanical ventilation with ARDS and low compliance. This manoeuvre may optimise ventilator settings during mechanical ventilation.


  • Author contributions: E. Rezoagli and L. Bastia conceived, drafted, revised and approved the work; L. Brochard and G. Bellani revised and approved the work. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Conflict of interest: All authors have no conflict of interest to disclose in relation to this work.

  • Support statement: This work was supported by institutional funding.

  • Received November 14, 2022.
  • Accepted March 30, 2023.