• Matteo Pozzi, Davide Raimondi Cominesi, Marco Giani, Leonello Avalli, Giuseppe Foti, Laurent J Brochard, Giacomo Bellani, and Emanuele Rezoagli.
• School of Medicine and Surgery, University of Milano-Bicocca, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
• Chest. 2023 Nov 1; 164 (5): e125e130e125-e130.

AbstractAirway closure is an underestimated phenomenon reported in hypoxemic respiratory failure under mechanical ventilation, during cardiac arrest, and in patients who are obese. Because airway and alveolar pressure are not communicating, it leads to an overestimation of driving pressure and an underestimation of respiratory system compliance. Airway closure also favors denitrogenation atelectasis. To date, it has been described mainly in patients with ARDS and those with obesity. We describe three cases of airway closure in patients with hydrostatic pulmonary edema caused by cardiogenic shock, highlighting its resolution in a limited period of time (24 h) as pulmonary edema resolved. The waveforms show a biphasic reopening that we refer to as the "uncorking effect". The detection of airway closure may require setting positive end-expiratory pressure at or above the airway opening pressure to avoid the overestimation of driving pressure.Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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