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Combined Approach with Ultrasound and Pressure-Volume Loops to Manage Mechanical Ventilation in Acute Hypoxemic Respiratory Failure

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dc.contributor.authorAguilera, Javiera
dc.contributor.authorAdrião, Diana
dc.contributor.authorMercado, Pablo
dc.contributor.authorSlama, Michel
dc.contributor.authorDe Vita, Nello
dc.contributor.authorVaschetto, Rosanna
dc.contributor.authorPozzi, Marco
dc.contributor.authorBouhemad, Belaïd
dc.contributor.authorMongodi, Silvia
dc.contributor.authorMojoli, Francesco
dc.date.accessioned2026-11-03T18:36:14Z
dc.date.available2026-11-03T18:36:14Z
dc.date.issued2026
dc.description.abstractAcute hypoxemic respiratory failure (AHRF), particularly acute respiratory distress syndrome (ARDS), is characterized by marked heterogeneity in lung morphology and mechanics, requiring individualized mechanical ventilation strategies that balance adequate gas exchange with the prevention of ventilator-induced lung injury (VILI). Lung ultrasound (LUS) has become a cornerstone of critical care imaging, allowing differential diagnosis, quantitative assessment of lung aeration, phenotyping of ARDS morphology, and monitoring of disease evolution and complications. However, imaging alone does not provide direct guidance for optimizing ventilator settings. Some modern ventilators enable the rapid bedside acquisition of tidal pressure-volume (PV) loops, allowing tidal hysteresis to be measured and thereby providing complementary physiological information by identifying cyclic opening and closing of lung units and signs of overdistension. Emerging evidence supports the use of tidal hysteresis thresholds to identify insufficient positive end-expiratory pressure (PEEP) associated with tidal recruitment/derecruitment and to guide individualized PEEP titration during decremental PEEP trials. This review discusses the rationale and practical implementation of an integrated approach combining critical care ultrasound and PV loops throughout the management of mechanically ventilated patients with AHRF. We describe how ultrasound can support diagnosis, phenotyping, monitoring of lung aeration, and detection of ventilation-related complications, while PV loops provide a practical physiological framework for optimizing ventilator settings. This approach may provide a comprehensive, non-invasive, and repeatable bedside assessment of lung morphology, aeration, and respiratory mechanics, potentially facilitating personalized mechanical ventilation strategies aimed at reducing the risk of VILI and optimizing patient management.
dc.description.versionVersión Publicada
dc.identifier.citationAguilera Scarpati, J., Adrião, D., Mercado, P., Slama, M., De Vita, N., Vaschetto, R., Pozzi, M., Bouhemad, B., Mongodi, S., & Mojoli, F. (2026). Combined Approach with Ultrasound and Pressure-Volume Loops to Manage Mechanical Ventilation in Acute Hypoxemic Respiratory Failure. Diagnostics (Basel, Switzerland), 16(20), 3339. https://doi.org/10.3390/diagnostics16203339
dc.identifier.doihttps://doi.org/10.3390/diagnostics16203339
dc.identifier.urihttps://hdl.handle.net/11447/11312
dc.language.isoen
dc.subjectARDS
dc.subjectPEEP setting
dc.subjectatelectrauma
dc.subjectheart–lung interaction
dc.subjectpersonalized mechanical ventilation
dc.subjectpoint-of-care ultrasound
dc.subjectpressure–volume loop
dc.subjectrecruitability
dc.subjectrecruitment
dc.titleCombined Approach with Ultrasound and Pressure-Volume Loops to Manage Mechanical Ventilation in Acute Hypoxemic Respiratory Failure
dc.typeArticle
dcterms.accessRightsAcceso Abierto
dcterms.sourceDiagnostics
dspace.entity.typePublication
relation.isAuthorOfPublication4e3332b1-7515-4993-8bf0-7a3d87a3a0e4
relation.isAuthorOfPublication.latestForDiscovery4e3332b1-7515-4993-8bf0-7a3d87a3a0e4

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