Application Effect of Stratified Nursing Intervention for ICU Mechanically Ventilated Patients in the Context of Aspiration Risk Assessment

Objective:To explore the application effect of stratified nursing intervention based on the background of misinspiration risk assessment in mechanically ventilated patients in intensive care unit(ICU).Methods:100 cases of mechanically ventilated patients who were admitted to the ICU of our hospital from March 2022 to March 2023 were selected and divided into an observation group and a control group according to the random number table method,with 50 cases in each of the two groups.The control group was given routine care in ICU,and the observation group was given stratified nursing interventions based on the background of the risk of aspiration assessment on the basis of the control group,and both groups were cared for until they were transferred out of the ICU,and the mechanical ventilation time,ICU stay time,muscle strength score,complication rate,adherence,and satisfaction were observed and compared between the two groups.Results:The mechanical ventilation time and ICU stay time of the observation group were shorter than that of the control group after the intervention;the muscle strength score,compliance and satisfaction of the observation group were higher than that of the control group after the intervention;and the complication rate of the observation group was lower than that of the control group after the intervention,all of which were P<0.05.Conclusion:The application of stratified nursing intervention based on the background of misaspiration risk assessment in ICU mechanically ventilated patients can improve the patient's muscle strength,shorten the time of mechanical ventilation,promote the patient's recovery,reduce the occurrence of complications,and improve the patient's compliance and satisfaction.

Analysis on the Effect of Yiqi Huoxue Decoction Combined with Neuromuscular Electrical Stimulation in Improving ICU-Acquired Debility in Mechanically Ventilated Patients

Objective:To investigate the effect of Yiqi Huoxue decoction combined with neuromuscular electrical stimulation on improving intensive care unit(ICU)acquired debility in mechanically ventilated patients.Methods:50 patients who were admitted to the ICU and received mechanical ventilation treatment in our hospital from June 2022 to June 2023 and were complicated with ICU-acquired neurasthenia were selected,and randomly grouped using the randomized envelope method into two groups:control group with 25 patients who received neuromuscular electrical stimulation alone;observation group with 25 patients who received the traditional Chinese medicine Yiqi Huoxue decoction.Comparison indexes:treatment efficiency,degree of emotional recovery(APACHEⅡscore),muscle strength status(MRC score),motor status(FAC rating),and self-care ability(BI index score).Results:The treatment efficiency of patients in the observation group patients was higher as compared to those in the control group(P<0.05).There was no significant difference in the comparison of the results of the scores(ratings)of each index between the two groups before treatment(P>0.05).After the treatment,the APACHEⅡscores of patients in the observation group were significantly lower as compared to those in the control group,while the MRC scores,FAC ratings,and BI index scores were higher in the observation group than those of the control group patients(P<0.05).Conclusion:The combined application of Yiqi Huoxue decoction and neuromuscular electrical stimulation in the treatment of patients with ICU-acquired neurasthenia complicated by mechanical ventilation significantly enhanced the clinical efficacy,the patient’s muscle strength,motor status,and ability of self-care.Hence,it has high application value and is worthy to be popularized.

Comparison of the Effectiveness of Marked Suction Tubes vs. Plain Suction Tubes in Pediatric Mechanically Ventilated Patients

Introduction: Endotracheal suction plays a crucial role in the management of mechanically ventilated patients. This study aims to evaluate the clinical effectiveness and safety of suction tubes with markings in mechanically ventilated pediatric patients. Materials and Methods: A randomized assignment was carried out on a cohort of 52 pediatric patients who underwent mechanical ventilation in the Pediatric Intensive Care Unit at the Third Affiliated Hospital of Sun Yat-sen University, covering the period from January 2022 to December 2022. These patients were divided into two groups: an improved group (n = 26) utilizing marked suction tubes, and a regular group (n = 26) employing conventional suction tubes. The objective of our study was to evaluate the clinical effectiveness of marked suction tubes. Results: The effects of the improved group on the vital signs of children undergoing mechanical ventilation were small and statistically significant compared with the regular group (p < 0.05). Additionally, the improved group exhibited a reduced frequency of sputum suction, shorter mechanical ventilation duration, and fewer days of hospitalization in the PICU compared to the regular group during the ventilation period. Notably, the difference in the duration of PICU hospitalization was statistically significant (p < 0.05). Moreover, the incidence of adverse reactions in the improved group was notably lower, with statistically significant differences observed in airway mucous membrane damage and irritating cough when compared to the regular group (p < 0.05). Conclusion: The utilization of marked suction tubes provides clinical nurses with clear guidance for performing suctioning with ease, efficiency and safety. Consequently, advocating for the widespread implementation of marked suction tubes in clinical practice is a commendable pursuit.

Smoke distribution in naturally ventilated urban transportation tunnels with multiple shafts

The smoke spreading law of urban transportation tunnels with multiple shafts under natural ventilation is studied.A full-scale burning experiment is conducted in an actual tunnel.The study shows that smoke temperatures below the tunnel ceiling reduce rapidly along the longitudinal towards the tunnel exits. A noticeable temperature stratification is observed near the fire source.Most fire smoke is exhausted out of the shafts while the number of the smoke shafts in the downstream is more than that in the upstream.Large eddy simulation LES based on computational fluid dynamics CFD is carried out using the fire dynamics simulator FDS software with parallel processing in which the grid size of the fire-domain is set to be 0.083 m.The simulation results of temperatures under the ceiling the smoke fronts and the shafts＇smoke exhaust or air supply agree reasonably with the experimental data. Further simulations indicate that the decreasing ambient temperature or shaft spacing might reduce smoke temperatures under the tunnel ceiling and increase mass flow rates out of the shafts.This study provides technical scientific evidence and supports for the design and construction of such kinds of tunnels.

Fuzzy Evaluation of Thermal Comfort in Naturally Ventilated Residential Buildings in China

In order to assess the differences between the human body thermal sensation in naturally ventilated space and that in air-conditioned space,the fuzzy evaluation model was adopted in the research of thermal sensation in naturally ventilated space.Based on the questionnaires and field measurements,the membership functions were presented by the statistic of the covering frequency to the fuzzy subset.Dry-bulb temperature was taken as the only independent variable for membership functions.The maximum values of membership grades are all at 0.5 or so,which is a distinction character on thermal comfort of naturally ventilated space.By the calculating results of membership grades value to different fuzzy evaluation subsets,the Predicted Mean Vote(PMV)was obtained.Furthermore,energy coefficient(Ea)was introduced to calculate the energy consumption,and the prediction methods of residential building energy consumption were also discussed.Finally,the importance of evaluation model of thermal sense is shown through the energy consumption prediction in a specific residential building.

Correlation of Inferior Vena Cava Respiratory Variability Index with Central Venous Pressure and Hemodynamic Parameters in Ventilated Pigs with Septic Shock

Septic shock is a common critical condition, for which effective early fluid resuscitation is the therapeutic focus. According to the 2008 international guidelines for management of severe sepsis and septic shock, resuscitation should achieve a central venous pressure （CVP） of 8-12 mmHg within the first 6 h. However, it is still uncertain about the sensitivity and specificity of CVP in reflecting the cardiac preload. Ultrasonography is a simple, rapid, non-invasive, and repeatable method for the measurement of sensitivity and specificity of CVP and has thus gradually attracted the increasing attention of physicians. It was reported that ultrasonography can show the inferior vena cava diameter, respiratory variability index, and blood volume in patients with sepsis or heart failure.

THREE DIMENSIONAL MULTIPHASE COMPUTATIONAL FLUID DYNAMICS ANALYSIS OF VENTILATED SUPERCAVITATION

For some vehicles travelling through water, it is advantageous to cover the vehicle in a supercavity for the sake of reducing the drag acting on it. The method of artificial ventilation is most effective for generating and dominating the supercavity. This paper focuses on the numerical simulation of flow field around three dimensional body. The method is based on the multiphase computational fluid dynamics （CFD） model combined with the turbulence model and the full cavity model. The flow field of cavity is simulated by solving the compressible Navier-Stokes equations. The fundamental similarity parameters of ventilated supercavitaty flows that include cavitation number, Froude number, ventilation rate and drag coefficient are all investigated numerically in the case of steady flow and gravity field. We discuss the following simulations results in section 3： The variations of the cavitation number and the supercavity＇s relative diameter with ventilation rate （subtopic 3.1）; The drag coefficient versus the cavitation number （subtopic 3.2）; Deformation of supercavity axis caused by gravitational effect for three different fixed Froude numbers-2.8, 3.4, 4.2 （subtopic 3.3）. In subtopic 3.2, we give the comparison results of the drag reduction ratio among numerical simulation and experiment conducted in hydrodynamic tunnel and towing tank respectively. In subtopic 3.3, we summarize our discussion of gravitational effect on the axis deformation of supercavity as follows： In the case of smaller Froude number, the inclination of the cavity axis increases monotonously with increasing horizontal length, and reaches its maximal value at the end of supercavity; This deformation can be almost completely negligible when the Froude number Fr〉7. The comparisons with the experimental data in the hydrodynamic tunnel and the towing tank indicate that the present method is effective for predicting the flows around ventilated supercavity; that the numerical results is in good agreement with the experimental ones and that the maximal value of the drag reduction ratio can reach 88% compared with that the condition of fully-wetted.

Challenging Problems on Ventilated Cavitation and Paths to Their Computational Solutions

Ventilated cavitation has been successfully employed as ship drag reduction technology and potentially can mitigate flowinduced vibration. The obtained successes were based on solutions of design problems considered in the framework of ideal fluid theory with their following validation by towing tank tests. However, various aspects of the interaction of ventilated cavities with the viscous flows around the ship hulls remain unclear, whereas there is usually no possibility to simultaneously keep the full-scale Froude number and cavitation number in the test facilities. So, the further progress of the application of ventilated cavitation substantially depends on the ability of computational tools to predict this interaction. This paper briefly describes the state-of-the-art computation of ventilated cavitation and points out the most challenging unsolved problems that appeared in the model tests (prediction of air demand by cavities, ventilation effect on ship drag, on hydrofoil lift, and on the propagation of shock waves in cavities).

Numerical Analysis of the Effects of Periodic Gust Flow on the Wake Structure of Ventilated Supercavities

A computational model is established to investigate the effects of a periodic gust flow on the wake structure of ventilated supercavities.The effectiveness of the computational model is validated by comparing with available experimental data.Benefited from this numerical model,the vertical velocity characteristics in the entire flow field can be easily monitored and analyzed under the action of a gust generator;further,the unsteady evolution of the flow parameters of the closed region of the supercavity can be captured in any location.To avoid the adverse effects of mounting struts in the experiments and to obtain more realistic results,the wake structure of a ventilated supercavity without mounting struts is investigated.Unsteady changes in the wake morphology and vorticity distribution pattern of the ventilated supercavity are determined.The results demonstrate that the periodic swing of the gust generator can generate a gust flow and,therefore,generate a periodic variation of the ventilated cavitation numberσ.At the peakσ,a re-entrant jet closure appears in the wake of the ventilated supercavity.At the valleyσ,a twin-vortex closure appears in the wake of the ventilated supercavity.For the forward facing model,the twin vortex appears as a pair of centrally rolled-up vortices,due to the closure of vortex is affected by the structure.For the backward facing model,however,the twin vortex appears alternately as a pair of centrally rolled-up vortices and a pair of centrally rolled-down vortices,against the periodic gust flow.

Numerical Study of the Transition Between Reentrant Jet and Twin Vortex Flow Regimes in Ventilated Cavitation

Contrary to natural cavitation,ventilated cavitation is controllable and is not harmful.It is particularly used to reduce the drag of the hydraulic vehicles.The ventilated cavitation is characterized by various gas regimes.The mechanisms of ventilated cavitation are investigated in the present work with CFD based on a 2D solver.The attention is especially focused on the transition between the reentrant jet and twin vortex regimes.The results confirmthat the product of ventilated cavitation number and Froude number is lower than 1(σcFr<1)in the twin vortex regime,while it is higher than 1(σcFr>1)in the reentrant jet regime,as reported in the literature.Further analysis shows that ventilated cavitation is significantly influenced by the natural cavitation number.

Numerical Modeling and Analysis of Gas Entrainment for the Ventilated Cavity in Vertical Pipe

A semi-empirical gas entrainment model was proposed for the ventilated cavity in vertical pipe, based on which, a complete numerical scheme was established by coupling with the Eulerian-Eulerian two-fluid model to predict the multiscale flow field created by ventilated cavity. Model predictions were validated against experimental measurements on void fraction and bubble size distributions. Simulations were carried out to explore the effect of ventilation rate and inlet turbulence intensity on the macroscale cavity shape and the bubbly flow downstream of the ventilated cavity. As the ventilation rate increasing, a reverse trend was observed for the void fraction and bub-ble size distributions. It is concluded that the average void fraction in the pipe flow region is determined by the vo-lumetric ratio between liquid and gas. However, the bubble size evolution is dominated by the breakage effect induced by turbulence in the vortex region. Furthermore, simulations were conducted to analyze geometric scale effect based upon Froude similitude. The results imply that the velocity distributions were properly scaled. Slight scale effect was seen for the void fraction caused by faster dispersion of bubbles in the larger size model. The comparatively greater bubble size was predicted in the smaller model, implying significant scale effects in terms of tur-bulence and surface tension effect. It reveals that empirical correlations valid in wide range are required for the extrapolation from small-size laboratory models.

Determination of the Minimum Wave Speed for the Modelling of Ventilated Cavitation

Ventilated cavitation plays an important role on the drag reduction of underwater vehicles and surface ships. For the modelling of ventilated cavitation, the minimum speed of the pressure wave is a crucial parameter for the closure of the pressure-density coupling relationship. In this study, the minimum wave speed is determined based on a theoretical model coupling the wave equation and the bubble interface motion equation. The influences of several paramount parameters （e.g., frequency, bubble radius and void fraction） on the minimum wave speed are quantitatively demonstrated and discussed. Compared with the minimum wave speed in the traditional cavitation, values for the ventilated cavitation are much higher. The physical mechanisms for the above difference are briefly discussed with the suggestions on the usage of the present findings.

Two mechanically ventilated cases of COVID-19 successfully managed with a sequential ventilation weaning protocol: Two case reports

BACKGROUND Patients with critical coronavirus disease 2019(COVID-19),characterized by respiratory failure requiring mechanical ventilation(MV),are at high risk of mortality.An effective and practical MV weaning protocol is needed for these fragile cases.CASE SUMMARY Here,we present two critical COVID-19 patients who presented with fever,cough and fatigue.COVID-19 diagnosis was confirmed based on blood cell counts,chest computed tomography(CT)imaging,and nuclei acid test results.To address the patients’respiratory failure,they first received noninvasive ventilation(NIV).When their condition did not improve after 2 h of NIV,each patient was advanced to MV[tidal volume(Vt),6 mL/kg ideal body weight(IBW);8-10 cmH2 O of positive end-expiratory pressure;respiratory rate,20 breaths/min;and 40%-80%FiO2]with prone positioning for 12 h/day for the first 5 d of MV.Extensive infection control measures were conducted to minimize morbidity,and pharmacotherapy consisting of an antiviral,immune-enhancer,and thrombosis prophylactic was administered in both cases.Upon resolution of lung changes evidenced by CT,the patients were sequentially weaned using a weaning screening test,spontaneous breathing test,and airbag leak test.After withdrawal of MV,the patients were transitioned through NIV and high-flow nasal cannula oxygen support.Both patients recovered well.CONCLUSION A MV protocol attentive to intubation/extubation timing,prone positioning early in MV,infection control,and sequential withdrawal of respiratory support,may be an effective regimen for patients with critical COVID-19.

Computational Analysis of Nanofluid Mixed Convection in a Ventilated Enclosure with Linearly Varying Wall Temperature

The characteristic of flow and heat transfer of A12Oa-water nanofluids flowing through a horizontal ventilated cavity is investigated numerically. The bottom wall is subjected to a linearly varying increasing heating temperature profile, whereas the other boundaries are assumed to be thermally insulated. The enclosure is cooled by an injected or sucked imposed flow. The simulations are focused specifically on the effects of different key parameters such as Reynolds number, 200 〈 Re 〈 5,000, nanoparticles concentration, 0 〈 φ 〈 0.1, and mode of imposed flow, on the flow and thermal patterns and heat transfer performances. The findings demonstrate clearly the positive role of the nanoparticles addition on the improvement of the heat transfer rate and the mean temperature within the cavity. Also, the results presented show that, the suction mode is more favorable to the heat transfer in comparison with the case of the injection mode. The cooling efficiency is found to be more pronounced by applying the suction mode.

Pollution of Airborne Fungi in Naturally Ventilated Repositories of the Provincial Historical Archive of Santiago de Cuba (Cuba)

Environmental fungi can damage the documentary heritage conserved in archives and affect the personnel’s health if their concentrations,thermo-hygrometric parameters and ventilation conditions are not adequate,problems that can be accentuated by Climate Change.The aims of this work were to identify and to characterize the airborne fungal pollution of naturally ventilated repositories in the Provincial Historical Archive of Santiago de Cuba and predict the risk that these fungi pose to the staff’s health.Indoor air of three repositories of this archive and the outdoor air were sampled in an occasion every time in 2015,2016 and 2017 using a SAS sampler.The obtained fungal concentrations varied from 135.6 CFU/m^(3) to 421.1 CFU/m^(3) and the indoor/outdoor ratios fluctuated from 0.7 to 4.2,evidencing a variable environmental quality over time,but in the third sampling the repositories environments showed good quality.Aspergillus and Cladosporium were the predominant genera in these environments.A.flavus was a prevailed species in indoor air,while A.niger and Cl.cladosporioides were the species that showed the greatest similarities with the outdoor air.Coremiella and Talaromyces genera as well as the species Aspergillus uvarum,Alternaria ricini and Cladosporium staurophorum were the first findings for environments of Cuban archives.Xerophilic species(A.flavus,A.niger,A.ochraceus,A.ustus)indicators of moisture problems in the repositories were detected;they are also opportunistic pathogens and toxigenic species but their concentrations were higher than the recommended,demonstrating the potential risk to which the archive personnel is exposed in a circumstantial way.

Convection Heat Transfer from Heated Thin Cylinders Inside a Ventilated Enclosure

Experimental study was conducted to determine the effect of velocity of axial fan,outlet vent height,position,area,and aspect ratio(h/w)of ventilated enclosure on convection heat transfer.Rectangular wooden ventilated enclosure having top and front transparent wall was made up of Perspex for visualization,and internal physical dimensions of box were 200 mm×200 mm×400 mm.Inlet vent was at bottom while outlet vents were at the side and top wall.Electrically heated cylindrical heat source having 6.1 slenderness ratio was fabricated and hanged at the centre of the enclosure.To calculate heat transfer rates,thermocouples were attached to the inner surface of heat source with silica gel.Heat source was operated at constant heat flux in order to quantify the effect of velocity of air on heat transfer.It was observed that average Nusselt number was increased from 68 to 216 by changing velocity from 0 to 3.34 m/s at constant modified Grashof number i.e.5.67E+09.While variation in outlet height at the front wall did not affect heat transfer in forced convection region.However,Nusselt number decreased to 5%by changing the outlet position from top to the front wall or by 50%reduction in outlet area during forced convection.Mean rise in temperature of enclosure increased from 8.19 K to 9.40 K by increasing aspect ratio of enclosure from 1.5 to 2 by operating heat source at constant heat flux i.e.541.20 w/m^(2).

Heat and hazardous contaminant transports in ventilated high-rise industrial halls

Performances and efficiencies of displacement ventilation(DV) and partial ventilation(PV) for industrial halls of different configurations as well as the heat and mass transports within the industrial halls were numerically investigated. Three levels of Rayleigh number(5.8×1010, 1.0×1012 and 2.1×1012) and two values of source contaminant flux(5 mg/s and 50 mg/s) were considered. The inlet Reynolds numbers were 2×104, 5×104, 1.5×105 and 4.5×105 for DV and 5×105, 1×106, 2×106 and 4×106 for PV, respectively. From the results, it is concluded that the above parameters have very complex impacts on the conjugated heat and mass transports. From points of view of acceptable indoor air quality and ventilation efficiency, PV at Re=1×106 with side-located sources and 65% of the supply air extracted through floor level outlets is the best choice when Ra=5.8×1010. However, DVs at Re=5×104 and Re=1.5×105with center-located sources and floor-mounted air suppliers are the best choices for Ra=1.0×1012 and Ra=2.1×1012, respectively. When source contaminant flux reaches 50 mg/s, local extraction as a supplement of general ventilation is recommended. The results can be a first approximation to 3D numerical investigation and preliminary ventilation system design guidelines for high-rise industrial halls.

Incidence and risk factors of gastrointestinal bleeding in mechanically ventilated patients

The widespread use of gastrointestinal bleeding prophylaxis in critically ill patients was one of the most controversial issues. Since few studies reported the incidence of gastrointestinal bleeding in mechanically ventilated patients, this study aimed to identify the incidence and risk factors related to gastrointestinal bleeding in patients undergoing mechanical ventilation for more than 48 hours. A total of 283 IOU patients who had received mechanical ventilation for longer than 48 hours at a provincial hospital affiliated to Shandong University from January 1,2007 to December 31, 2009 were analyzed retrospectively. Those were excluded from the study if they had a history of gastrointestinal bleeding or ulceration, recent gastrointestinal surgery, brain death and active bleeding from the nose or throat. Demographic data of the patients included patient age, diagnosis on admission, duration of ICU stay, duration of ventilation, patterns and parameters of ventilation, ICU mortality, APACHE II score, multiple organ dysfunction, and indexes of biochemistry, kidney function, liver function and coagulation function. Risk factors of gastrointestinal bleeding were analyzed by univariate analysis and multiple logistic regression analysis. In the 242 patients who were given mechanical ventilation longer than 48 hours, the incidence of gastrointestinal bleeding was 46.7%. The bleeding in 3.3% of the patients was clinically significant. Significant risk factors were peak inspiratory pressure 〉30cmH2O, renal failure, liver failure, PLT count〈50xl09/L and prolonged APTT. Enteral nutrition had a beneficial effect on gastrointestinal bleeding. However, the multiple logistic regression analysis revealed that the independent risk factors of gastrointestinal bleeding were as follows： high pressure ventilator setting 〉 30cmH2O（RR=3.478, 95%CI=2.208-10.733）, renal failure（RR=1 .687, 95%CI=1.098-3.482）, PLT count〈50×10^9/L （RR=3.762, 95%CI=2.346-14.685）, and prolonged APTT（RR=5.368, 95%CI=2.487-11.266）. Enteral nutrition（RR=0.436, 95%CI= 0.346-0.764） was the independent protective factor. The incidence of gastrointestinal bleeding was high in the patients who received mechanical ventilation, and bleeding usually occurred within the first 48 hours. High pressure ventilator setting, renal failure, decreased PLT count and prolonged APTT were the significant risk factors of gastrointestinal bleeding. However, enteral nutrition was the independent protective factor.

Effect of Ventilation Strategies on Particle Distribution in a Two-Zone Ventilated Room

A computational fluid dynamic （ CFD ） analysis of air movement and aerosol particle transport in a two-zone ventilated room with an inter-zonal opening is presented to study the impact of ventilation strategies and size of the opening on indoor particle dispersion and concentration distribution. The comparisons of average particle concentrations in both zones between the computations and the experiments from the literature are generally satisfactory and acceptable. The combined effects of sizes of the opening and the inlet and outlet locations （three different strategies） are simulated and discussed. The results show that ventilation strategy and size of the opening influence the particle removal rate in zone 1. The removal rate is decreased when the air supply system is changed from the tap-inlet to the bottom-inlet configuration. The top-inlet system obtains a better particle deposition in zone I than the bottom-inlet configuration. However, the particle concentration at breathing level is lower for bottomsupply system than for top-supply. Decreasing the size of interzonal opening increases the particle deposition rate in zone 1 only for the top.supply system, especially for coarse particles.

Expiratory flow-limitation in mechanically ventilated patients: A risk for ventilator-induced lung injury?

Expiratory flow limitation(EFL), that is the inability of expiratory flow to increase in spite of an increase of the driving pressure, is a common and unrecognized occurrence during mechanical ventilation in a variety of intensive care unit conditions. Recent evidence suggests that the presence of EFL is associated with an increase in mortality, at least in acute respiratory distress syndrome(ARDS) patients, and in pulmonary complications in patients undergoing surgery. EFL is a major cause of intrinsic positive end-expiratory pressure(PEEPi), which in ARDS patients is heterogeneously distributed, with a consequent increase of ventilation/perfusion mismatch and reduction of arterial oxygenation. Airway collapse is frequently concomitant to the presence of EFL.When airways close and reopen during tidal ventilation, abnormally high stresses are generated that can damage the bronchiolar epithelium and uncouple small airways from the alveolar septa, possibly generating the small airways abnormalities detected at autopsy in ARDS. Finally, the high stresses and airway distortion generated downstream the choke points may contribute to parenchymal injury, but this possibility is still unproven. PEEP application can abolish EFL, decrease PEEPi heterogeneity, and limit recruitment/derecruitment.Whether increasing PEEP up to EFL disappearance is a useful criterion for PEEP titration can only be determined by future studies.