Driving pressure in mechanical ventilation: A review

Abstract

Driving pressure (∆P) is a core therapeutic component of mechanical ventilation (MV). Varying levels of ∆P have been employed during MV depending on the type of underlying pathology and severity of injury. However, ∆P levels have also been shown to closely impact hard endpoints such as mortality. Considering this, conducting an in-depth review of ∆P as a unique, outcome-impacting therapeutic modality is extremely important. There is a need to understand the subtleties involved in making sure ∆P levels are optimized to enhance outcomes and minimize harm. We performed this narrative review to further explore the various uses of ∆P, the different parameters that can affect its use, and how outcomes vary in different patient populations at different pressure levels. To better utilize ∆P in MV-requiring patients, additional large-scale clinical studies are needed.

Driving Pressure During Mechanical Ventilation of Acute Respiratory Distress Syndrome

“…In the realm of ARDS patient care, the metric of Driving Pressure (DP), delineated as the discrepancy between the end-inspiratory airway pressure (specifically, the plateau pressure (Pplat)) and Positive End-Expiratory Pressure (PEEP), has been elucidated as a more potent prognosticator of mortality relative to the metrics of low Tidal Volume (VT) and Pulmonary Compliance (Ppl),Notably, the mortality risk's relative increment was pronouncedly significant upon surpassing a DP threshold of 18 cm H2O. It warrants specific mention that the establishment of a DP range from 14 to 18 cmH2O as a predictive benchmark for outcomes or as a calibration standard for VT adjustment lacks empirical validation and confirmation (4)(5)(6)(7) .…”