Effect of Higher or Lower PEEP on Pendelluft During Spontaneous Breathing Efforts in Acute Hypoxemic Respiratory Failure
Bibliographic record
Abstract
Background: In acute hypoxemic respiratory failure (AHRF), spontaneous breathing effort can generate excessive regional lung stress and strain manifesting as pendelluft. Higher PEEP may reduce pendelluft and reduce regional lung stress and strain during spontaneous breathing. This study aimed to establish whether higher or lower PEEP ameliorates pendelluft and to characterize factors determining the presence and magnitude of pendelluft during spontaneous breathing efforts. Methods: This study was a randomized crossover trial of higher versus lower PEEP applied after systematically initiating spontaneous breathing in subjects with moderate or severe AHRF. The presence and volume of pendelluft were assessed by electrical impedance tomography (EIT). Results: EIT recordings were available for 20 of 30 subjects enrolled in the trial. After initiating spontaneous breathing, 11/20 exhibited pendelluft (proportion 55% [95% CI 32–76]). Following PEEP titration, the prevalence of pendelluft was not different between higher versus lower PEEP levels (50% vs 50%, P = .55). When present, pendelluft volume was generally small (median 28 [interquartile range 8–93] mL) but ranged as high as 364 mL. Pendelluft was associated with higher respiratory effort (esophageal pressure [P es ] swing [ΔP es ] median −15 cm H 2 O vs ΔP es median −8 cm H 2 O, P = .01), higher pulmonary flow resistance (median 8 cm H 2 O/L/s vs median 3 cm H 2 O/L/s, P < .001), and higher dynamic pulmonary elastance (median 5.0 cm H 2 O/mL/kg predicted body weight vs median 3.2 cm H 2 O/mL/kg predicted body weight, P = .03). Conclusions: Pendelluft reflecting increased regional lung stress and strain is likely common during spontaneous breathing effort in patients with AHRF but was not systematically affected by applying higher PEEP. The presence and magnitude of pendelluft depended on respiratory effort and lung mechanics.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".