{
  "abstract": "Rationale: In intubated patients, occlusion maneuvers allow noninvasive assessment of inspiratory effort, respiratory drive, and lung mechanics.\n\nObjectives: To assess the feasibility of occlusion maneuvers during noninvasive ventilation (NIV).\n\nMethods: In this multicenter study, 60 hypoxemic patients underwent 2 randomized 1-hour NIV sessions with oronasal and full-face masks after extubation. End-expiratory and end-inspiratory occlusions measured expiratory occlusion pressure (Pocc), 100-ms airway pressure drop (P0.1), and plateau pressure. Esophageal manometry, calibrated before extubation, provided reference values for inspiratory effort, assessed as esophageal pressure swing (ΔPes) and dynamic transpulmonary driving pressure (ΔPL,dyn = pressure support − ΔPes). Interface-specific conversion factors (K) translating Pocc into predicted ΔPes (K × Pocc) and predicted ΔPL,dyn (pressure support − predicted ΔPes) were derived through 100-interaction cross-validation (20-patient derivation set, 40-patient validation set).\n\nMeasurements and Main Results: Pocc was measurable in all patients. Mean K was 0.71 with the oronasal mask and 0.80 with the full-face mask. Predicted ΔPes agreed with observed ΔPes (oronasal: bias −0.41 cm H2O, 95% limits of agreement −2.3 to 1.5; full-face: 0.09, −2.9 to 3.1), and predicted ΔPL,dyn agreed with observed ΔPL,dyn (oronasal bias: 0.03, −2.9 to 2.9; full-face: −0.04, −4.3 to 4.2). Predicted ΔPes identified observed ΔPes ≤ −10 cm H2O, with areas under the receiver operating characteristic curve of 0.98 (oronasal) and 0.97 (full-face). Ventilator-derived P0.1 did not precisely quantify respiratory drive, but values >2.7 cm H2O with the oronasal mask and >3 cm H2O with the full-face mask identified high drive with specificity >90%. Plateau pressure was unstable in 78% (oronasal) and 90% (full-face) of patients. More negative predicted ΔPes, higher predicted ΔPL,dyn, and lower predicted lung compliance (expiratory tidal volume/predicted ΔPL,dyn) were associated with subsequent reintubation.\n\nConclusions: During NIV, Pocc-derived parameters provide noninvasive estimates of inspiratory effort, lung stress, and mechanics, whereas ventilator P0.1 and plateau pressure are less reliable.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 19,
  "authors": [
    {
      "name": "Francesco Murgolo",
      "orcid": "0000-0003-1014-3016"
    },
    {
      "name": "Domenico Luca Grieco",
      "orcid": "0000-0002-4557-6308"
    },
    {
      "name": "Rossana Soloperto"
    },
    {
      "name": "Michele Bertoni"
    },
    {
      "name": "Savino Spadaro"
    },
    {
      "name": "Nicola Bartolomeo"
    },
    {
      "name": "Tommaso Pettenuzzo"
    },
    {
      "name": "François Beloncle"
    },
    {
      "name": "Delphine Venkatapen"
    },
    {
      "name": "Alessandro Cardu"
    },
    {
      "name": "Tommaso Rosà"
    },
    {
      "name": "Chiara Iacovelli"
    },
    {
      "name": "Paolo Navalesi"
    },
    {
      "name": "Salvatore M Maggiore"
    },
    {
      "name": "Ewan C Goligher"
    },
    {
      "name": "V Marco Ranieri"
    },
    {
      "name": "Lorenzo del Sorbo",
      "orcid": "0000-0003-3294-9838"
    },
    {
      "name": "Massimo Antonelli"
    },
    {
      "name": "Salvatore Grasso",
      "orcid": "0000-0002-0287-0232"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/f1bpetaf5fjvb.bib",
  "cited_by": 1,
  "doi": "10.1093/ajrccm/aamag293",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13721124/",
  "id": "f1bpetaf5fjvb",
  "issns": [
    "1073-449X",
    "1535-4970"
  ],
  "landing_url": "https://doi.org/10.1093/ajrccm/aamag293",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00010"
    ],
    [
      "heading",
      "AcademicSubjects/MED00160"
    ],
    [
      "heading",
      "AcademicSubjects/MED00350"
    ],
    [
      "heading",
      "Critical Care"
    ],
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2740|Respiratory Support and Mechanisms"
    ]
  ],
  "openalex": "W7164732668",
  "pdf_url": null,
  "pmcid": "PMC13721124",
  "pmid": "42287717",
  "published": "2026-06-13",
  "publisher": "American Thoracic Society",
  "ris": "https://research.draconitic.com/paper/f1bpetaf5fjvb.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T12:21:52Z",
      "native_id": "PMC13721124",
      "source": "pmc",
      "url": "https://doi.org/10.1093/ajrccm/aamag293"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Respiratory Support and Mechanisms",
      "subfield": "general"
    }
  ],
  "title": "Airway occlusions to measure inspiratory effort, respiratory drive, and lung mechanics during noninvasive ventilation",
  "title_text": "Airway occlusions to measure inspiratory effort, respiratory drive, and lung mechanics during noninvasive ventilation",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:21:52Z",
  "url": "https://research.draconitic.com/paper/f1bpetaf5fjvb",
  "venue": "American Journal of Respiratory and Critical Care Medicine",
  "versions": []
}