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Regional physiology of ARDS

Overview of attention for article published in Critical Care, December 2017
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (96th percentile)
  • High Attention Score compared to outputs of the same age and source (85th percentile)

Mentioned by

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108 tweeters
facebook
6 Facebook pages

Citations

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32 Dimensions

Readers on

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220 Mendeley
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Title
Regional physiology of ARDS
Published in
Critical Care, December 2017
DOI 10.1186/s13054-017-1905-9
Pubmed ID
Authors

Luciano Gattinoni, Tommaso Tonetti, Michael Quintel

Abstract

The acute respiratory distress (ARDS) lung is usually characterized by a high degree of inhomogeneity. Indeed, the same lung may show a wide spectrum of aeration alterations, ranging from completely gasless regions, up to hyperinflated areas. This inhomogeneity is normally caused by the presence of lung edema and/or anatomical variations, and is deeply influenced by the gravitational forces.For any given airway pressure generated by the ventilator, the pressure acting directly on the lung (i.e., the transpulmonary pressure or lung stress) is determined by two main factors: 1) the ratio between lung elastance and the total elastance of the respiratory system (which has been shown to vary widely in ARDS patients, between 0.2 and 0.8); and 2) the lung size. In severe ARDS, the ventilatable parenchyma is strongly reduced in size ('baby lung'); its resting volume could be as low as 300 mL, and the total inspiratory capacity could be reached with a tidal volume of 750-900 mL, thus generating lethal stress and strain in the lung. Although this is possible in theory, it does not explain the occurrence of ventilator-induced lung injury (VILI) in lungs ventilated with much lower tidal volumes. In fact, the ARDS lung contains areas acting as local stress multipliers and they could multiply the stress by a factor ~ 2, meaning that in those regions the transpulmonary pressure could be double that present in other parts of the same lung. These 'stress raisers' widely correspond to the inhomogenous areas of the ARDS lung and can be present in up to 40% of the lung.Although most of the literature on VILI concentrates on the possible dangers of tidal volume, mechanical ventilation in fact delivers mechanical power (i.e., energy per unit of time) to the lung parenchyma, which reacts to it according to its anatomical structure and pathophysiological status. The determinants of mechanical power are not only the tidal volume, but also respiratory rate, inspiratory flow, and positive end-expiratory pressure (PEEP). In the end, decreasing mechanical power, increasing lung homogeneity, and avoiding reaching the anatomical limits of the 'baby lung' should be the goals for safe ventilation in ARDS.

Twitter Demographics

The data shown below were collected from the profiles of 108 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 220 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 220 100%

Demographic breakdown

Readers by professional status Count As %
Other 33 15%
Researcher 33 15%
Student > Postgraduate 23 10%
Student > Bachelor 17 8%
Student > Master 16 7%
Other 56 25%
Unknown 42 19%
Readers by discipline Count As %
Medicine and Dentistry 142 65%
Nursing and Health Professions 10 5%
Biochemistry, Genetics and Molecular Biology 3 1%
Agricultural and Biological Sciences 3 1%
Veterinary Science and Veterinary Medicine 2 <1%
Other 11 5%
Unknown 49 22%

Attention Score in Context

This research output has an Altmetric Attention Score of 63. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 28 March 2020.
All research outputs
#453,407
of 19,141,916 outputs
Outputs from Critical Care
#329
of 5,556 outputs
Outputs of similar age
#15,360
of 425,755 outputs
Outputs of similar age from Critical Care
#31
of 211 outputs
Altmetric has tracked 19,141,916 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 97th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,556 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 17.4. This one has done particularly well, scoring higher than 94% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 425,755 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 96% of its contemporaries.
We're also able to compare this research output to 211 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 85% of its contemporaries.