Intensive Care Medicine

, Volume 45, Issue 12, pp 1838–1839 | Cite as

Airway closure and fiberoptic evidence of bronchial collapse during the acute respiratory distress syndrome

  • Caterina Malatesta
  • Francesco Mele
  • Luca Salvatore Menga
  • Giuseppe Bello
  • Domenico Luca GriecoEmail author
  • Massimo Antonelli

Dear Editor,

Airway closure affects approximatively one-third of patients with acute respiratory distress syndrome (ARDS) undergoing mechanical ventilation in the absence of spontaneous breathing [1, 2]. When this phenomenon is present, airways collapse during expiration; therefore, end-expiratory pressure at airway opening (although measured during an end-expiratory occlusion) is not equilibrated with alveolar pressure, and tidal inflation starts only when an airway opening pressure (AOP) is overcome. Airway closure leads to misinterpretation of static respiratory mechanics and makes actual end-expiratory alveolar pressure (and end-expiratory lung volume) independent from set PEEP, if this is lower than the AOP [3]. Moreover, airway opening and closing may yield bronchiolotrauma, which can contribute to lung injury [1, 4, 5].

The exact cause of airway closure is not known, but its occurrence seems related to surface tension modifications (i.e. gas–liquid interfacing) in terminal...


Compliance with ethical standards

Conflicts of interest

DLG has received payments for travel expenses by Maquet, Getinge and Air Liquide, and supported by grants from ESICM (2017 Draeger Award) and SIAARTI (2017 MSD award). MA has received payments for Board participation from Maquet, Air Liquide and Chiesi. DLG and MA disclose a research Grant by GE healthcare. All the other authors declare that no confict of interest exists regarding the material discussed in the manuscript.

Supplementary material

134_2019_5800_MOESM1_ESM.pdf (161 kb)
Supplementary material 1 (PDF 160 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Istituto di Anestesiologia e RianimazioneUniversità Cattolica del Sacro CuoreRomeItaly
  2. 2.Scienze dell’emergenza, anestesiologiche e della rianimazioneFondazione Policlinico Universitario A Gemelli IRCCSRomeItaly

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