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It is most utilized in patients with acute respiratory distress syndrome ARDS. Its primary function is to overcome the elastic forces of the pulmonary system. It is derived from the difference between end-inspiratory airway pressure, commonly known as the plateau pressure Pplat , and positive end-expiratory pressure PEEP in the absence of spontaneous respiration[ 1 - 4 ]. It reflects the pressure difference within a singular breath and is one of the major parameters implicated in lung stress[ 5 , 6 ].
Even though it is commonly used across critical care centers around the globe, it is a measure that requires further introspection to harness its predictive potential and guide safe and effective ventilation. Mechanical ventilation allows gas exchange and attenuates increased work of breathing in the setting of an acute compromise of the respiratory system. The mechanics are expressed through indices such as pressure, flow, volume, resistance, work of breathing, and compliance, which directly influence lung volumes, functional residual capacity, and the resulting gas exchange[ 5 ].
Physiologically, the respiratory circuit works as a negative pressure system. On inspiration, the diaphragm is pushed down, and negative pleural cavity pressure is generated. A net negative pressure in the airway serves as a suction for air to be brought into the lungs.
The negative pressure then, in turn, decreases the right atrial pressure and generates a similar suction effect in the inferior vena cava, which results in an increase in venous return[ 14 ].
