In the injured lung, local negative pleural pressure generated by diaphragmatic contraction is not uniformly transmitted, but is concentrated in dependent lung. This causes Pendelluft (using EIT), with shift of air from non-dependent to dependent lung regions. Thus, during lung-protective ventilation with strictly limited tidal volume, the presence of strong inspiratory effort can result in a hidden, local over-stretch of the dependent lung.

International Steering Committee on Electrical Impedance Tomography
15th International Conference on Biomedical Applications of Electrical Impedance Tomography (EIT 2014)
International Steering Committee on Electrical Impedance Tomography

Yoshida, T., Torsani, V., Gomes, S., De Santis, R.R., Beraldo, M., Tucci, M.R., … Amato, M.B.P. (2014). Spontaneous effort causes occult Pendelluft during mechanical ventilation. In 15th International Conference on Biomedical Applications of Electrical Impedance Tomography (EIT 2014). International Steering Committee on Electrical Impedance Tomography.