Driving pressure guided ventilation

Ahn, Hyun Joo; Park, MiHye; Kim, Jie Ae; Yang, Mikyung; Yoon, Seo-Yeon; Kim, Bo Rim; Bahk, Jae Hyon; Oh, Young Jun; Lee, Eun‐Ho

doi:10.4097/kja.20041

Cited by 24 publications

(25 citation statements)

References 56 publications

(108 reference statements)

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“…It is because the tidal volume was different between the two groups, and the tidal volume affects the magnitude of the driving pressure [ 22 ]. Cstat is tidal volume/driving pressure [ 14 ], and there was no difference in Cstat between the PV and CV groups (Fig. 6 ), resulting in no statistical difference in lung ultrasound scores.…”

Section: Discussionmentioning

confidence: 99%

“…In the PV group, patients were provided with a tidal volume of 8 ml/kg IBW and an intraoperative 6 cmH 2 O PEEP. In the DV group, based on a previous study [ 14 ], PEEP was increased from 5 cm H 2 O to 15 cmH 2 O before titration, with 5 cmH 2 O intervals for recruitment. Each PEEP level was maintained for 4–5 respiratory cycles (< 90 s required).…”

Section: Methodsmentioning

confidence: 99%

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Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial

Liu

et al. 2022

BMC Anesthesiol

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Background Driving pressure (ΔP = Plateau pressure-PEEP) is highly correlated with postoperative pulmonary complications (PPCs) and appears to be a promising indicator for optimizing ventilator settings. We hypothesized that dynamic, individualized positive end-expiratory pressure (PEEP) guided by ΔP could reduce postoperative atelectasis and improve intraoperative oxygenation, respiratory mechanics, and reduce the incidence of PPCs on elderly patients undergoing laparoscopic surgery. Methods Fifty-one elderly patients who were subject to laparoscopic surgery participated in this randomized trial. In the PEEP titration group (DV group), the PEEP titration was decremented to the lowest ΔP and repeated every 1 h. Additional procedures were also performed when performing predefined events that may be associated with lung collapse. In the constant PEEP group (PV group), a PEEP of 6 cmH2O was used throughout the surgery. Moreover, zero PEEP was applied during the entire procedure in the conventional ventilation group (CV group). The primary objective of this study was lung ultrasound score noted at the end of surgery and 15 min after admission to the post-anesthesia care unit (PACU) at 12 lung areas bilaterally. The secondary endpoints were perioperative oxygenation function, expiratory mechanics, and the incidence of the PPCs. Results The lung ultrasound scores of the DV group were significantly lower than those in the PV group and CV group (P < 0.05), whereas there was no significant difference between the PV group and CV group (P > 0.05). The lung static compliance (Cstat) and ΔP at all the intraoperative time points in the DV group were significantly better compared to the PV group and the CV group (p < 0.05). Conclusions Intraoperative titrated PEEP reduced postoperative lung atelectasis and improved respiratory mechanics in elderly patients undergoing laparoscopic surgery. Meanwhile, standard PEEP strategy is not superior to conventional ventilation in reducing postoperative pulmonary atelectasis in laparoscopic surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial

Liu

et al. 2022

BMC Anesthesiol

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“… 10 13 26 P peak is commonly reflected C dyn of the entire respiratory system, 27 and under isovolumetric conditions, C dyn is not only related to the elastic properties of the respiratory system but also resistive elements of the respiratory mechanism such as airway pressure. 13 28 On the other hand, P mean , the average pressure of the respiratory system throughout the inspiratory phase, corresponds to mean alveolar pressure, and an increase in P mean seems to be closely related to increased oxygenation by recruiting collapsed alveoli and reducing shunt. 27 29 30 P mean is one of the most critical factors related to gas exchange and it determines the recruitment of collapsed alveoli and redistribution of alveolar blood flow.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Perioperative Atelectasis Using Lung Ultrasonography in Patients Undergoing Pneumoperitoneum Surgery in the Trendelenburg Position: Aspects of Differences according to Ventilatory Mode

et al. 2021

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Background During robotic gynecologic pneumoperitoneum surgery in the Trendelenburg position, aeration loss leads to perioperative atelectasis. Recently developed ventilator mode pressure-controlled ventilation volume-guaranteed (PCV-VG) mode could provide adequate ventilation with lower inspiratory pressure compared to volume-controlled ventilation (VCV); we hypothesized that PCV-VG mode may be beneficial in reducing perioperative atelectasis via low tidal volume (V T ) of 6 mL/kg ventilation during robotic gynecologic pneumoperitoneum surgery in the Trendelenburg position. We applied lung ultrasound score (LUS) for detecting perioperative atelectasis. We aimed to compare perioperative atelectasis between VCV and PCV-VG with a low V T of 6 mL/kg during pneumoperitoneum surgery in the Trendelenburg position using LUS. Methods Patients scheduled for robotic gynecologic surgery were randomly allocated to the VCV (n = 41) or PCV-VG group (n = 41). LUS, ventilatory, and hemodynamic parameters were evaluated at T1 (before induction), T2 (10 minutes after induction in the supine position), T3 (10 minutes after desufflation of CO 2 in the supine position), and T4 (30 minutes after emergence from anesthesia in the recovery room). Results Eighty patients (40 with PCV-VG and 40 with VCV) were included. Demographic data showed no significant differences between the groups. The total LUS has changed from baseline to T4, 0.63 (95% confidence interval [CI], 0.32, 0.94) to 1.77 (95% CI, 1.42, 2.21) in the VCV group and 0.86 (95% CI, 0.56, 1.16) to 1.43 (95% CI, 1.08, 1.78) in the PCV-VG group ( P = 0.170). In both groups, total LUS increased significantly compared to the baseline values. Conclusion Using a low V T of 6 mL/kg during pneumoperitoneum surgery in the Trendelenburg position, our study showed no evidence that PCV-VG ventilation was superior to VCV in terms of perioperative atelectasis. Trial Registration Clinical Research Information Service Identifier: KCT0006404

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“…A previous study that explored the level of electrical impedance tomography-guided PEEP that minimizes lung collapse and hyperdistention showed that individualized PEEP reduced postoperative atelectasis and improved intraoperative oxygenation. 27 In fact, low tidal volumes and driving pressure, 28 rather than PEEP combined with lung RMs, are known to be responsible for lung protection in the intraoperative period. 7 In this study, we assessed loss of lung aeration during the perioperative period and examined whether a commonly used PV strategy using low tidal volume is associated with more atelectasis compared to CV.…”

Section: Discussionmentioning

confidence: 99%

Effects of Intraoperative Ventilation Strategy on Perioperative Atelectasis Assessed by Lung Ultrasonography in Patients Undergoing Open Abdominal Surgery: a Prospective Randomized Controlled Study

Cho

Choi

et al. 2020

J Korean Med Sci

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Background: Protective mechanical ventilation using low tidal volume has been introduced to surgical patients to reduce the incidence of postoperative pulmonary complications. We investigated the effects of protective ventilation (PV) techniques on anesthesia-induced atelectasis identified via lung ultrasonography in patients undergoing abdominal surgery. Methods: A total of 42 adult patients who were scheduled for open abdominal surgery with an expected duration > 2 hours were included in the study. Patients were randomized to receive either conventional ventilation (CV; tidal volume of 9-10 mL/kg predicted body weight [PBW] with no positive end-expiratory pressure [PEEP]) or PV (tidal volume of 6-8 mL/kg PBW and 5 cmH 2 O PEEP) via pressure-controlled ventilation with volume guaranteed. Lung ultrasonography was performed at four predefined time points to assess perioperative atelectasis by dividing each hemithorax into six quadrants based on a modified lung ultrasound (LUS) scoring system. Results: The tidal volume delivered to patients was 9.65 ± 1.65 mL/kg PBW in the CV group and 6.31 ± 0.62 mL/kg PBW in the PV group. Ventilation using low tidal volume led to similar LUS scores in all lung areas and at all time points compared to ventilation using high tidal volume. There was no significant difference between the groups in the number of patients requiring recruitment maneuvers at the end of surgery. Conclusion: Ventilation with low tidal volume combined with 5 cmH 2 O PEEP did not cause further loss of aeration compared to ventilation with high tidal volume. Low tidal volume ventilation can be used in patients without lung injury based on lung assessment by bedside lung ultrasonography.

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Driving pressure guided ventilation

Cited by 24 publications

References 56 publications

Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial

Effects of dynamic individualized PEEP guided by driving pressure in laparoscopic surgery on postoperative atelectasis in elderly patients: a prospective randomized controlled trial

Assessment of Perioperative Atelectasis Using Lung Ultrasonography in Patients Undergoing Pneumoperitoneum Surgery in the Trendelenburg Position: Aspects of Differences according to Ventilatory Mode

Effects of Intraoperative Ventilation Strategy on Perioperative Atelectasis Assessed by Lung Ultrasonography in Patients Undergoing Open Abdominal Surgery: a Prospective Randomized Controlled Study

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