Abstract
Respiratory system mechanics are influenced by the elastic properties of both elements of the series-coupled lung and chest wall.1 Intraabdominal pressure (IAP) is a major contributor to chest wall elastance (and to its inverse, compliance).1,2 Consequently, an increase in IAP typically results in an increase in plateau airway pressure (Pplat) and a parallel decrease in respiratory system compliance (Crs), calculated as tidal volume divided by driving pressure.1,2 Recently, we have encountered multiple patients with severe ARDS caused by advanced COVID-19 (C-ARDS) who exhibited paradoxical and reproducible responses to increasing IAP, characterized by decreases in Pplat and increases in calculated Crs.
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