• Roberto Tonelli, Salvatore Grasso, Andrea Cortegiani, Lorenzo Ball, Ivana Castaniere, Luca Tabbì, Riccardo Fantini, Dario Andrisani, Filippo Gozzi, Antonio Moretti, Giulia Bruzzi, Linda Manicardi, Stefania Cerri, Anna Valeria Samarelli, Giulia Raineri, Francesco Murgolo, Andrea Carzoli, Rossella Di Mussi, Stefano Busani, Raffaella Rizzoni, Giacomo Grasselli, Enrico Clini, and Alessandro Marchioni.
• Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University Hospital of Modena, University of Modena Reggio Emilia, Modena, Italy.
• Crit Care. 2023 Oct 18; 27 (1): 398398.

BackgroundAlthough patients with interstitial pneumonia pattern (ILD-UIP) and acute exacerbation (AE) leading to severe acute respiratory failure may require invasive mechanical ventilation (MV), physiological data on lung mechanics during MV are lacking. We aimed at describing the physiological effect of lung-protective ventilation in patients with AE-ILD-UIP compared with primary ARDS.MethodsPartitioned lung and chest wall mechanics were assessed in a series of AE-ILD-UIP patients matched 1:1 with primary ARDS as controls (based on BMI and PaO2/FiO2 ratio). Three PEEP levels (zero = ZEEP, 4-8 cmH2O = PEEPLOW, and titrated to achieve positive end-expiratory transpulmonary pressure PL,EE = PEEPTITRATED) were used for measurements.ResultsTen AE-ILD-UIP patients and 10 matched ARDS were included. In AE-ILD-UIP median PL,EE at ZEEP was - 4.3 [- 7.6- - 2.3] cmH2O and lung elastance (EL) 44 [40-51] cmH2O/L. At PEEPLOW, PL,EE remained negative and EL did not change (p = 0.995) versus ZEEP. At PEEPTITRATED, PL,EE increased to 0.8 [0.3-1.5] cmH2O and EL to 49 [43-59] (p = 0.004 and p < 0.001 compared to ZEEP and PEEPLOW, respectively). ΔPL decreased at PEEPLOW (p = 0.018) and increased at PEEPTITRATED (p = 0.003). In matched ARDS control PEEP titration to obtain a positive PL,EE did not result in significant changes in EL and ΔPL.ConclusionsIn mechanically ventilated AE-ILD-UIP patients, differently than in patients with primary ARDS, PEEP titrated to obtain a positive PL,EE significantly worsened lung mechanics.© 2023. BioMed Central Ltd., part of Springer Nature.

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