ICU Transpulmonary Pressure Simulator

⌨ Keyboard Shortcuts

Space

Pause / Resume animation

Inspiratory pause

Freezes waveform at end-inspiration to read plateau Paw and inspiratory PL

Expiratory pause

Freezes waveform at end-expiration to read PEEP and expiratory PL

Switch to Normal mechanics profile

Switch to ARDS profile

Switch to Obesity profile

Toggle fullscreen mode

Ideal for projector or bedside teaching

Toggle dark / light theme

Show / hide this shortcuts panel

Esc

Exit fullscreen or close this panel

⚖️ Same settings — different patients

Adjust sliders to see how the same ventilator settings produce different pressures in each patient

PEEP 5 cmH₂O

Drive ΔP 18 cmH₂O

Normal

Paw plateau—

Pes—

Exp PL—

Insp PL—

ΔPL—

Obesity

Paw plateau—

Pes—

Exp PL—

Insp PL—

ΔPL—

ARDS

Paw plateau—

Pes—

Exp PL—

Insp PL—

ΔPL—

🧑‍⚕️ Patient

Normal mechanics

Lungs and chest wall are compliant. Risks are minimal at standard pressures.

🫁 Lung Cl 50 mL/cmH₂O

🦴 Chest wall Cw 100 mL/cmH₂O

⚙️ Ventilator Settings Pressure Control

PEEP 8 cmH₂O

Tidal Volume 8 mL/kg IBW

PAW

cmH₂O

PES

cmH₂O

Insp PL

—

cmH₂O

Overlay

Paw

Pes

RR 12 /min I:E 1 : 2 T_i 1.67s

📊 Monitor

Paw

Pes

PEEP titration guide

—

Insp P_L < 20–25 cmH₂O
Exp P_L 0 to +2 cmH₂O
ΔPaw < 15 cmH₂O (ARDS: <13)
ΔPL transpulmonary < 10–12 cmH₂O (ARDS)
PEEP titrated to Exp P_L 0–+2
Plateau Paw < 28–30 cmH₂O (ARDS)

Transpulmonary pressure is the pressure gradient across the lung — the difference between airway pressure and pleural pressure. Esophageal pressure (Pes) is a validated surrogate for pleural pressure in passively ventilated patients. When Pes is high (e.g. obesity), a high Paw may not reflect true lung stress — only P_L reveals what the lung is actually experiencing.