Bench-to-bedside review: Chest wall elastance in acute lung injury/acute respiratory distress syndrome patients

Luciano Gattinoni, Davide Chiumello, Eleondra Carlesso, Franco Valenza

Research output: Contribution to journalArticlepeer-review


The importance of chest wall elastance in characterizing acute lung injury/acute respiratory distress syndrome patients and in setting mechanical ventilation is increasingly recognized. Nearly 30% of patients admitted to a general intensive care unit have an abnormal high intra-abdominal pressure (due to ascites, bowel edema, ileus), which leads to an increase in the chest wall elastance. At a given applied airway pressure, the pleural pressure increases according to (in the static condition) the equation: pleural pressure = airway pressure × (chest wall elastance / total respiratory system elastance). Consequently, for a given applied pressure, the increase in pleural pressure implies a decrease in transpulmonary pressure (airway pressure - pleural pressure), which is the distending force of the lung, implies a decrease of the strain and of ventilator-induced lung injury, implies the need to use a higher airway pressure during the recruitment maneuvers to reach a sufficient transpulmonary opening pressure, implies hemodynamic risk due to the reductions in venous return and heart size, and implies a possible increase of lung edema, partially due to the reduced edema clearance. It is always important in the most critically ill patients to assess the intra-abdominal pressure and the chest wall elastance.

Original languageEnglish
Pages (from-to)350-355
Number of pages6
JournalCritical Care
Issue number5
Publication statusPublished - Oct 2004


  • Acute respiratory distress syndrome
  • Chest wall elastance
  • Intra-abdominal pressure
  • Pleural pressure
  • Ventilator-induced lung injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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