NIV in a COVID-19 patient. Notice the large inspiratory tidal volume of around 1 liter with each breath.
The inspiratory pressure is 16 cm H2O and the PEEP is 10 cm H2O, therefore, his ventilator driving pressure is 6 cm H2O but with the patient's huge inspiratory efforts, the transpulmonary pressure is much larger than 6 cm H2O. This patient has a high work of breathing (WOB) and he is at risk of self-inflicted lung injury leading to pneumomediastinum and pneumothorax,