End-inspiratory pause (EIP) prolongation decreases dead space-to-tidal volume ratio and partial pressure of carbon dioxide in arterial blood (PaCO2). We do not know the physiological benefits of this approach to improve respiratory system mechanics in acute respiratory distress syndrome (ARDS) patients when mild hypercapnia is of no concern. Aguirre-Bermeo et al, therefore, set out to address this unknown.
They found that prolonging EIP allowed a significant decrease in tidal volume without changes in PaCO2 in passively ventilated ARDS patients. This produced a significant decrease in plateau pressure and driving pressure and significantly increased respiratory system compliance, which suggests less overdistension and less dynamic strain.
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