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Normally, the pressure within the pleural cavity is slightly less than the atmospheric pressure, which is known as negative pressure. [1] When the pleural cavity is damaged or ruptured and the intrapleural pressure becomes greater than the atmospheric pressure, pneumothorax may ensue. Intrapleural pressure is different from intrathoracic pressure.
IPI is a real-time patient value, updated every second, always available to the caregiver. An IPI trend graph also shows IPI scores over the previous hour (or other set time period), indicating if the IPI is remaining steady or trending up or down, thus reflecting changes in pulmonary status over time.
Pulmonary compliance is calculated using the following equation, where ΔV is the change in volume, and ΔP is the change in pleural pressure: = For example, if a patient inhales 500 mL of air from a spirometer with an intrapleural pressure before inspiration of −5 cm H 2 O and −10 cm H 2 O at the end of inspiration.
The partial pressure of carbon dioxide, along with the pH, can be used to differentiate between metabolic acidosis, metabolic alkalosis, respiratory acidosis, and respiratory alkalosis. Hypoventilation exists when the ratio of carbon dioxide production to alveolar ventilation increases above normal values – greater than 45mmHg.
Dynamic compression of the airways results when intrapleural pressure equals or exceeds alveolar pressure, which causes dynamic collapsing of the lung airways. It is termed dynamic given the transpulmonary pressure (alveolar pressure − intrapleural pressure) varies based on factors including lung volume, compliance, resistance, existing pathologies, etc. [1]
Image illustrating transpulmonary, intrapleural and intra-alveolar pressure. Alveolar pressure (P alv) is the pressure of air inside the lung alveoli. When the glottis is opened and no air is flowing into or out of the lungs, alveolar pressure is equal to the atmospheric pressure, that is, zero cmH 2 O. [1] [2]
The alveolar pressure is estimated by measuring the pressure in the airways while holding one's breath. [2] The intrapleural pressure is estimated by measuring the pressure inside a balloon placed in the esophagus. [2] Measurement of transpulmonary pressure assists in spirometry in availing for calculation of static lung compliance.
In contrast, tension pneumothorax is a medical emergency and may be treated before imaging – especially if there is severe hypoxia, very low blood pressure, or an impaired level of consciousness. In tension pneumothorax, X-rays are sometimes required if there is doubt about the anatomical location of the pneumothorax.