 Partitioning passive recoil equilibrium

Partitioning passive recoil equilibrium separates the elastic pressure contributions of the lung and chest wall at a shared volume. With transpulmonary pressure $P_L=P_{\mathrm{alv}}-P_{\mathrm{pl}}$ and wall pressure $P_W=P_{\mathrm{pl}}-P_{\mathrm{surface}}$,At a passive, open-airway equilibrium the total is zero, but the lung and wall contributions can be equal and opposite rather than individually zero. Their pressure references determine what is being added.^[ref]

The component-elastance ambiguity in total recoil measurements persists away from equilibrium. An original linear family writeswhere $E>0$ is total stiffness and $0<\lambda <1$. Every choice of $p_0$ and $\lambda$ produces the identical total curve $P_{\mathrm{rs}}=E(V-V_{\ast })$. Measuring that total curve alone cannot identify either the baseline pressure partition or the component slopes.

For stipulated $E=10\mathrm{cm}{\mathrm{H}}_2\mathrm{O}{\mathrm{L}}^{-1}$, $V_{\ast }=2.5$ L and $p_0=7.5$ cm water, choosing $\lambda =0.5$ gives equal component slopes of 5. Choosing $\lambda =0.8$ gives slopes 8 and 2. At equilibrium both cases even have the same component pressures, $+7.5$ and $-7.5$. After a 0.5 L increase, the pressure increments are either 2.5 plus 2.5 or 4 plus 1 cm water. Both totals equal 5 cm water.

The respective lung compliances are 0.20 and $0.125\mathrm{L}(\mathrm{cm}{\mathrm{H}}_2\mathrm{O}{)}^{-1}$, while the chest-wall compliances are 0.20 and 0.50. The combined compliance is 0.10 in either case. Thus one equilibrium internal-pressure reading, in addition to the total curve, still does not determine both component slopes.

A measurement series with a justified pleural pressure estimate supplies the missing partition across volume. The 1959 primary study used an intra-esophageal balloon, a mouthpiece connection and differential pressure recording to obtain such internal mechanical information.^[ref] The estimate's positioning and relation to pleural pressure require validation. Passive conditions matter as well: respiratory-muscle pressure would add another contribution to an equation intended to describe elastic recoil alone.