Transpulmonary pressure

The importance of precise definitions and limiting assumptions

Stephen H. Loring, George P. Topulos, Rolf D. Hubmayr

Research output: Contribution to journalReview article

27 Citations (Scopus)

Abstract

Recent studies applying the principles of respiratory mechanics to respiratory disease have used inconsistent and mutually exclusive definitions of the term "transpulmonary pressure." By the traditional definition, transpulmonary pressure is the pressure across the whole lung, including the intrapulmonary airways, (i.e., the pressure difference between the opening to the pulmonary airway and the pleural surface). However, more recently transpulmonary pressure has also been defined as the pressure across only the lung tissue (i.e., the pressure difference between the alveolar space and the pleural surface), traditionally known as the "elastic recoil pressure of the lung." Multiple definitions of the same term, and failure to recognize their underlying assumptions, have led to different interpretations of lung physiology and conclusions about appropriate therapy for patients. It is our view that many current controversies in the physiological interpretation of disease are caused by the lack of consistency in the definitions of these common physiological terms. In this article, we discuss the historical uses of these terms and recent misconceptions that may have resulted when these terms were confused. These misconceptions include assertions that normal pleural pressure must be negative (subatmospheric) and that a pressure in the pleural space may not be substantially positive when a subject is relaxed with an open airway. We urge specificity and uniformity when using physiological terms to define the physical state of the lungs, the chest wall, and the integrated respiratory system.

Original languageEnglish (US)
Pages (from-to)1452-1457
Number of pages6
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume194
Issue number12
DOIs
StatePublished - Dec 15 2016

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Pressure
Lung
Respiratory Mechanics
Thoracic Wall
Respiratory System

Keywords

  • Breathing
  • Esophageal pressure
  • Mechanical ventilation
  • Pleural pressure
  • Respiratory mechanics

ASJC Scopus subject areas

  • Medicine(all)
  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Transpulmonary pressure : The importance of precise definitions and limiting assumptions. / Loring, Stephen H.; Topulos, George P.; Hubmayr, Rolf D.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 194, No. 12, 15.12.2016, p. 1452-1457.

Research output: Contribution to journalReview article

Loring, Stephen H. ; Topulos, George P. ; Hubmayr, Rolf D. / Transpulmonary pressure : The importance of precise definitions and limiting assumptions. In: American Journal of Respiratory and Critical Care Medicine. 2016 ; Vol. 194, No. 12. pp. 1452-1457.
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