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Tension is present in 60% to 96% of ventilated PTX cases (19,20) and signifies that pleural pressure exceeds atmospheric pressure.
Furthermore, although PEEP does increase right atrial pressure, the associated SVC-distending effect will be opposed by an accompanying identical or greater increase in pleural pressure (5).
During the Mueller's maneuver, in the absence of flow, negative pleural pressure will equilibrate with lung parenchymal pressure, which will equilibrate with thoracic airway pressure, which will equilibrate with upper airway pressure.