Driving Pressure in ARDS: Improving Survival By Any Means Necessary

Patients placed on mechanical ventilation carry a certain mortality by default. Obviously it is not a good thing to end up intubated in the ICU. It’s one thing to set up a patient on mechanical ventilation and then just twist the knobs to get a pretty arterial blood gas that’s satisfactory to keep the patient alive. It’s another thing to really stand there and tinker with how the ventilator interacts with the patient. This is where this look into driving pressure comes in.

I feel the need to dive a bit into this topic because, although the data has been out since 2015 with the Amato Observational study, many clinicians just don’t read. In that study, the authors defined driving pressure as “ΔP=VT/CRS“. VT stands for tidal volume and CRS stands for compliance of the respiratory system. Some might say that the math is too hard but another way to calculate is in patients “not making respiratory efforts” is the plateau pressure minus PEEP. More to come. I got pulled away and will finish writing soon. These are busy times my friends.

Citations
Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, Stewart TE, Briel M, Talmor D, Mercat A, Richard JC, Carvalho CR, Brower RG. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med. 2015 Feb 19;372(8):747-55. doi: 10.1056/NEJMsa1410639. PMID: 25693014.
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Loring SH, Malhotra A. Driving pressure and respiratory mechanics in ARDS. N Engl J Med. 2015 Feb 19;372(8):776-7. doi: 10.1056/NEJMe1414218. PMID: 25693019; PMCID: PMC4356532.
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Boscolo A, Sella N, Lorenzoni G, Pettenuzzo T, Pasin L, Pretto C, Tocco M, Tamburini E, De Cassai A, Rosi P, Polati E, Donadello K, Gottin L, De Rosa S, Baratto F, Toffoletto F, Ranieri VM, Gregori D, Navalesi P; COVID-19 VENETO ICU Network. Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS. Crit Care. 2021 Jul 28;25(1):263. doi: 10.1186/s13054-021-03667-6. PMID: 34321047.
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To check out my other posts on mechanical ventilation CLICK HERE.

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