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Intensive Care Medicine Experimental
Fig. 1 | Intensive Care Medicine Experimental

Fig. 1

From: Fluid management strategies and their interaction with mechanical ventilation: from experimental studies to clinical practice

Fig. 1

Adapted from Vieillard-Baron et al. [20]

Hemodynamic changes in controlled and assisted mechanical ventilation. In pressure-support ventilation, pleural pressure (Ppl) is lowered by inspiratory efforts, leading to higher venous return and lower right ventricular (RV) afterload. Increased transmural pressure (caused by the decrease in Ppl from inspiratory effort) increases hydrostatic pressure (Ph) in the microvasculature, worsening edema. Increased flow in lung vessels may also lead to shear stress, causing further endothelial damage and protein and fluid leak into alveolar space. Transvascular filtration pressure (PTvF) is higher in pressure-support ventilation than in pressure control ventilation (even at the same transpulmonary pressure (Ptp) given by the difference between alveolar pressure (Palv) and Ppl).

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