Airway and tissue mechanics in ventilated patients with pneumonia

We applied the low-frequency forced oscillation technique (LFOT) to measure respiratory impedance (Zrs) at various positive end-expiratory pressures (PEEPs) in 14 sedated and intubated patients with pneumonia classified into a mild (Group 1) and a severe group (Group 2) based on lung injury scores. The Zrs spectra were fit with the constant-phase (CP) model including Newtonian resistance (RN) and tissue damping (G) and elastance (H), a distributed airway resistance (DR) and a distributed tissue elastance (DH) model. Using the CP model, all parameters revealed a negative PEEP dependence (p < 0.001) in Group 2 and H was higher in Group 2 (p = 0.014). The variability of H from the DH model was nearly significantly larger in Group 1 (p = 0.061). Following bronchodilator inhalation, G significantly decreased (p = 0.009). Thus, the CP model provides a robust partitioning of Zrs into tissue properties and RN, a surrogate for airway resistance, while the distributed models suggest that lung heterogeneity decreases with increasing PEEP.