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An end-expiratory hold is an interruption of airflow at the end of exhalation during which airway pressure is observed while the respiratory system is occluded. In an appropriate passive, leak-free measurement it can assess total positive end-expiratory pressure, including intrinsic positive end-expiratory pressure. The set external pressure alone need not equal this measured total.^[ref]

The mechanical reason is easiest to see in one communicating compartment. With airway resistance $R$, let $Q=(P_{\mathrm{alv}}-P_{\mathrm{aw}})/R$ relate airflow to the difference between alveolar pressure and measured airway pressure. Once flow vanishes and pressure has equilibrated through the communicating airway, this model gives $P_{\mathrm{aw}}=P_{\mathrm{alv}}$. Zero flow removes the resistive pressure drop; it does not mean that either pressure is zero.

For stipulated pressures, an external setting of $5$ and an equilibrated total of $8\mathrm{cm}{\mathrm{H}}_2\mathrm{O}$ differ by $3\mathrm{cm}{\mathrm{H}}_2\mathrm{O}$. If plateau airway pressure is $23\mathrm{cm}{\mathrm{H}}_2\mathrm{O}$, respiratory driving pressure is $23-8=15\mathrm{cm}{\mathrm{H}}_2\mathrm{O}$, whereas subtracting the external setting would give 18. These constructed values illustrate reference selection, not patient settings.

Occlusion changes the boundary condition rather than directly opening every lung region to the sensor. A compartment isolated by airway closure cannot be assumed to equilibrate with the measured opening. Active muscular effort, a leak or a pressure trace that has not settled also defeats the simple passive-compartment inference. The observed airway-pressure plateau and the inferred regional alveolar pressure must therefore remain distinct.

An end-inspiratory hold is a pause after inflation during which the airway is occluded and external flow is interrupted. Under passive, leak-free conditions, the resulting pressure trace helps distinguish flow-related airway resistance from the pressure remaining at approximately fixed lung volume. A stable endpoint provides a plateau airway pressure for interpreting respiratory-system compliance.^[ref]

Stopping flow does not imply that every compartment instantaneously reaches a common pressure. Stress relaxation, redistribution between lung regions and the apparatus response can produce a continuing pressure change after the rapid resistive drop. The measured value should therefore identify the observation interval, rather than treating the first post-interruption sample as universally equilibrated.

For an original illustrative trace, suppose flowing peak pressure is 26 cm H${}_2$O and stopping flow immediately removes 4 cm H${}_2$O. Let the subsequent relaxation beThe initial hold value is 22 cm H${}_2$O, about 19.47 remains after 0.5 s, and about 18.20 after 1.5 s. The model's long-time value is 18. The change from 26 to 22 and the later change from 22 toward 18 represent different mechanisms in this constructed example.

With total end-expiratory pressure 8 cm H${}_2$O, using the initial hold value gives a nominal respiratory driving pressure of 14, whereas using the asymptotic value gives 10 cm H${}_2$O. The difference demonstrates the importance of time and model assumptions; it does not prescribe a hold duration. Continued muscle activity, leakage or airway closure can invalidate the simple static interpretation. The experimental pilot study compares static and dynamic measurement methods rather than assuming all displayed pressure estimates are interchangeable.^[ref]

Peak airway pressure, $P_{\mathrm{peak}}$, is the largest measured airway pressure over the specified breath or inspiratory interval. Its meaning includes the measurement location, reference pressure and temporal response. At the airway opening during positive-pressure inflation, the peak can include the pressure needed for flow through resistance as well as the pressure distending the respiratory system.^[ref]

For a passive single-compartment model with constant airway resistance $R$ and respiratory-system compliance $C$,Here $V$ is volume above the end-expiratory state and $Q$ is inspiratory flow. If constant flow persists to the end of inspiration, the largest volume and the resistive pressure occur together, givingWith varying flow, the peak is instead the maximum of the time-dependent sum; separate maxima cannot automatically be added.

An original example takes total end-expiratory pressure 5 cm H${}_2$O, tidal volume 0.50 L, $C=0.05$ L/cm H${}_2$O and $Q=0.50$ L/s. For $R=10$ cm H${}_2$O·s/L, peak pressure is $5+10+5=20$ cm H${}_2$O. Doubling resistance raises the calculated peak to 25 cm H${}_2$O while the equilibrated plateau airway pressure stays 15 cm H${}_2$O. A larger peak can therefore occur without a larger static distending increment.

An end-inspiratory hold removes ongoing airway flow under appropriate conditions and helps separate these contributions. Active respiratory effort, leaks, nonlinear resistance or delayed redistribution complicate that separation. Peak pressure alone neither partitions lung and chest-wall loading nor establishes a unique cause of a pressure change.

Plateau airway pressure, $P_{\mathrm{plat}}$, is the airway pressure assessed during an end-inspiratory interval with no flow and sufficiently stable conditions. An end-inspiratory hold can allow the airway and communicating alveolar gas pressures to equilibrate when the respiratory system is passive and the circuit is not leaking.^[ref][ref]

The distinction from peak airway pressure follows a simple single-compartment model:During the modeled hold, $\dot{V}=0$, leavingHere $C$ is respiratory-system compliance, $R$ is airway resistance, and total positive end-expiratory pressure supplies the starting reference. The measured difference $P_{\mathrm{plat}}-P_{\mathrm{EEP},\mathrm{total}}$ is the corresponding respiratory driving pressure.

In an original example, total PEEP 8 cm H${}_2$O, tidal volume 0.40 L and compliance 0.04 L/cm H${}_2$O give $P_{\mathrm{plat}}=18$ cm H${}_2$O. If flow immediately beforehand is 0.5 L/s and resistance is 12 cm H${}_2$O·s/L, the model's airway pressure during that flow is 24 cm H${}_2$O. The 6 cm H${}_2$O difference is the modeled resistive contribution, not an extra static distending pressure.

A plateau does not directly measure pleural pressure or isolate the lung from the chest wall. For the same stipulated alveolar pressure 18 cm H${}_2$O, pleural pressures of 12 and 2 cm H${}_2$O imply transpulmonary pressures of 6 and 16 cm H${}_2$O. The airway value alone cannot distinguish those states.

Finally, a stable displayed number is not automatically the same operation as an actual hold. The manufacturer distinguishes measured holds, rapid occlusion and calculated monitoring estimates.^[ref] Reporting the method and its conditions connects plateau airway pressure to the mechanical question it can answer.

Positive end-expiratory pressure, PEEP, is airway pressure maintained above atmospheric pressure at the end of exhalation. It specifies an end-expiratory pressure reference, not a tidal volume or a pressure rise measured from the beginning to the end of inspiration. A set external pressure and the total pressure assessed during an appropriate end-expiratory hold need not be identical.^[ref]

One reason is incomplete emptying. In an original passive single-compartment model, let $V$ be excess volume above equilibrium with the prescribed outlet pressure. With airway resistance $R$ and respiratory-system compliance $C$,The remaining elastic pressure above the outlet is $V(t)/C$. Stipulated $R=20$ cm H${}_2$O·s/L and $C=0.05$ L/cm H${}_2$O give a time constant of 1 s. Starting with 0.50 L excess volume, after 0.5 s the model retains about 0.303 L, corresponding to 6.07 cm H${}_2$O above the outlet pressure. These are constructed mechanics, not ventilator settings for a person.

If the prescribed outlet reference is 5 cm H${}_2$O, the modeled retained elastic pressure raises the equilibrated total to about 11.07 cm H${}_2$O. This illustrates intrinsic positive end-expiratory pressure: a pressure contribution that cannot be identified from the external setting alone. The result assumes a communicating passive compartment; active effort, leakage and heterogeneous time constants require further interpretation.

Respiratory driving pressure compares plateau airway pressure with total PEEP, rather than silently subtracting an external setting that may omit retained pressure. The manufacturer's primary measurement account states that distinction and the required passive, leak-free conditions.^[ref] Naming the pressure reference is therefore part of defining the reported mechanical quantity.

Positive-pressure ventilation assists inhalation by raising pressure at the airway opening, driving gas into the lungs when that pressure exceeds alveolar pressure. It differs mechanically from spontaneous expansion of the thorax or negative-pressure ventilation, which lowers pressure around the lungs to produce the relevant distending difference. A ventilator's mask or tube supplies the applied airway connection.^[ref]

The direction of flow still depends on a pressure difference, not on whether either pressure is above atmospheric. For a simple resistive path,with positive $Q$ directed inward and $R$ the airway resistance. In an original example, pressures 10 and 8 cm H${}_2$O and $R=4$ cm H${}_2$O·s/L give inward flow 0.5 L/s. Pressures 8 and 10 cm H${}_2$O give outward flow 0.5 L/s. Both pairs are positive relative to atmosphere.

This explains why positive end-expiratory pressure can coexist with exhalation. The applied pressure can remain above atmospheric while elastic recoil produces a still higher alveolar pressure and drives gas outward. At equal opening and alveolar pressures, the same ideal resistive model gives zero flow.

The resulting tidal volume also depends on respiratory-system compliance, airway resistance, duration and any active respiratory muscle effort. The no-flow interval used to interpret plateau airway pressure removes one resistive contribution only under the required measurement conditions.^[ref] Positive pressure is therefore a mode of applying mechanical assistance, not a guarantee of a particular inward flow, volume or gas-exchange result.

Respiratory driving pressure, $\Delta P$, is the difference between plateau airway pressure and total end-expiratory pressure when measured under suitable passive conditions:The total baseline includes intrinsic positive end-expiratory pressure when present; substituting only the externally imposed baseline can overestimate this tidal pressure difference.^[ref]

For the linear static model, respiratory-system compliance is $C_{\mathrm{rs}}=V_T/\Delta P$. An original calculation with tidal volume 0.45 L, plateau pressure 23 cm H${}_2$O and total baseline 8 cm H${}_2$O gives $\Delta P=15$ cm H${}_2$O and $C_{\mathrm{rs}}=0.030$ L/cm H${}_2$O. If the external baseline alone were 5 cm H${}_2$O, incorrectly subtracting it would give 18 cm H${}_2$O and a different apparent compliance.

This pressure difference loads both the lung and chest wall. At static endpoints, transpulmonary pressure gives the partitionThus a stipulated airway increment of 12 cm H${}_2$O corresponds to a lung increment of 4 when the pleural increment is 8, but to a lung increment of 10 when the pleural increment is 2. Equal airway driving pressures do not establish equal lung distension without information about the chest-wall contribution.

The measurement method matters as much as the subtraction. A dynamic estimate during flow can include resistance; an end-inspiratory hold and an end-expiratory occlusion address different endpoints. The primary pilot study explicitly compared static and dynamic ways of obtaining whole-respiratory-system compliance and driving pressure.^[ref] These distinctions explain the quantity's mechanical meaning without turning an illustrative number into an individual ventilation recommendation.

Respiratory-system compliance is the change in volume per change in elastic pressure across the passive lung and chest wall together. For a local static relation,Lung compliance alone instead uses transpulmonary pressure, $P_L=P_{\mathrm{alv}}-P_{\mathrm{pl}}$. The whole-system and lung-only quantities are different even when they refer to the same volume change.

At that shared volume, the elastic pressure increments add. With component compliances $C_L$ and $C_W$,The reciprocals are component stiffnesses; respiratory-system elastance is $E_{\mathrm{rs}}=1/C_{\mathrm{rs}}$. For positive component compliances, the combined value is smaller than either component. OpenStax describes opposing lung and wall recoil and their pressure references.^[ref]

An original example uses $C_L=0.20$ and $C_W=0.10\mathrm{L}(\mathrm{cm}{\mathrm{H}}_2\mathrm{O}{)}^{-1}$. The combined compliance is about 0.0667 in the same units. An added 0.50 L requires 2.5 cm water of lung elastic pressure and 5 cm water of wall pressure, totaling 7.5 cm water. Attributing that total entirely to the lung would underestimate lung-only compliance threefold.

In a passive ventilated-breath measurement, a zero-flow plateau airway pressure can be compared with the appropriately measured end-expiratory pressure. Under the stated equilibrium and no-effort assumptions, an interval estimate isFor stipulated $V_T=0.5$ L, $P_{\mathrm{plat}}=12.5$ and $P_{\mathrm{end}}=5$ cm water, this is again about 0.0667. The baseline must account for the relevant positive end-expiratory pressure; a pressure measured during nonzero flow also contains a resistive contribution. The primary pilot study explicitly compares pressure-based respiratory-system estimates under passive ventilation.^[ref]

State whether the number is a local slope or an interval ratio, which pressure references were used, and whether muscle activity and flow were excluded. Separating lung and wall contributions requires internal pressure information beyond the whole-system volume response.

A ventilator is a machine that assists or replaces pulmonary ventilation by supplying a controlled gas-delivery path to the lungs. The interface can be a mask or a breathing tube; the machine and interface together support mechanical ventilation.^[ref] Gas delivery, oxygen concentration and respiratory mechanics remain distinct parts of that support.

A useful engineering description separates the commanded quantity from the measured response. A machine can regulate an applied pressure or a flow history while monitoring pressure and gas volume. Its displayed or reconstructed quantities depend on sensors, timing and the selected model. The manufacturer's treatment of plateau airway pressure, for example, distinguishes a hold measurement from computed monitoring estimates and states conditions under which they are available.^[ref]

An original circuit example shows why upstream delivered volume need not equal the volume entering the patient. In a simplified volume balance,If a stipulated source supplies 0.50 L, ventilator circuit compliance stores 0.04 L during pressurization, and 0.06 L escapes through a leak, only 0.40 L reaches the modeled patient compartment. This is an illustrative uncompensated circuit, not a description of every ventilator's displayed tidal volume.

The stored term can be approximated as $\Delta V_{\mathrm{circuit}}=C_{\mathrm{circuit}}\Delta p$. A stipulated compliance of 2 mL/cm H${}_2$O with a 20 cm H${}_2$O pressure rise gives the stated 40 mL. Measuring volume at another location, or compensating for known circuit properties, changes what is being reported.

A ventilator consequently supplies an experimentally testable physical system: gas path, actuation, sensors and control logic. A pressure or volume setting alone is not a complete observation of alveolar gas renewal, especially when flow, leakage or circuit storage changes.