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Related to Transpulmonary pressure: alveolar pressure, intrapleural pressure
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During the transient interruption of expiratory flow, the mouth pressure was assumed to equilibrate to the transpulmonary pressure and so it was used in the above equation together with the expiratory flow rate recorded just prior to occlusion.
Although transpulmonary pressure (P[sub]L) could reflect the lung mechanics, the P[sub]L stress index would require an esophageal catheter and a more complex calculation whereas the airway pressure (P[sub]aw) stress index is measured noninvasively.
To this date, the variable that best evaluates lung overstretching is transpulmonary pressure.
In general, if transpulmonary pressure does not go beyond 30-35 cm water alveolar rupture almost never occurs.
This was probably due to the fact that resistance was calculated via a modification of von Neergard and Wirz method (at mid-tidal volume by dividing inspiratory transpulmonary pressure by inspiratory flow), and thus measuring the average inspiratory and expiratory resistance, instead of the inspiratory.