Driving pressure-guided ventilation versus protective lung ventilation in ARDS patients: A prospective randomized controlled study

Hamama, Khaled M.; Fathy, Sameh M; AbdAlrahman, Reda S.; Alsherif, Salah El-din I.; Ahmed, Sameh Abdelkhalik

doi:10.1080/11101849.2021.1930401

Cited by 4 publications

(2 citation statements)

References 26 publications

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“…There were significant differences in DP between weaning success and weaning failure and between alive and dead. This is in line with Hamama et al who reported that, the reduced rate of mortality may be attributed to the use of DP guided ventilation for patients with ARDS (17) . The retrospective analysis of several studies in patients with ARDS comparing different PEEP levels at the same VT or different VT levels at the same PEEP, or a combination of both, suggested that DP (the difference between Pplat and PEEP) was a strong predictor of mortality as compared with low VT and Ppl.…”

Section: Discussionsupporting

confidence: 90%

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Driving Pressure During Mechanical Ventilation of Acute Respiratory Distress Syndrome

Abdelhameed,

Al-Asmar,

Ali

et al. 2024

SJMS

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Background: Driving pressure has been identified as a more accurate indicator of mortality risk than low tidal volume (VT) and pulmonary compliance (Ppl). It was also noted that when this pressure surpasses the 18 cm H2O mark, there is a significant elevation in the relative risk of death. This study aimed to evaluate the effect of driving pressure guided ventilation in acute respiratory distress syndrome (ARDS). Patients and Methods: The study included 64 subjects selected from the respiratory intensive care unit (RICU) of Al-Azhar University Hospital (Damietta). All participants received management through a protective lung strategy that was informed by driving Pressure. The study outcomes included 1). Determination of weaning categories; 2). Adverse events; 3). Length of ICU stay and duration of mechanical ventilation; 4). Mechanical Ventilation-free days, and 5). Organ/s dysfunction. Results: The commonest cause of admission was pneumonia (36%), and least percentage was septic shock (1.6%). The median ICU stay was 7 days (4 to 25 days) and weaning success rate was 76.6% with mortality rate of 23.4%. The severity was mainly severe (40.6%) and moderate (31.2%). Driving pressure at day 1 of ≤ 21 had sensitivity of 97.96%, specificity of 80.0% and area under curve (AUC) of 0.952. The driving pressure was significantly increased in cases with failure weaning than the success weaning (24.67 ± 1.05 vs 16.86 ± 1.24, respectively). In addition, it was significantly increased in died than alive patients. There was progressive significant increase of driving pressure from mild to moderate to severe cases. Pneumothorax was recorded among 9.4% and pleural effusion was recorded for 7.8% of patients. Conclusion: Use of driving pressure guided ventilation in patients with ARDS improves lung compliance, decreases the duration of mechanical ventilation and the length of ICU stay. Driving pressure < 21 can predict mortality.

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Section: Discussionsupporting

confidence: 90%

“…In the current study, pneumothorax was occurred in 6 patients (9.4%) while pleural effusion was occurred in 5 patients (7.8%). Other studies such as the study of Hamama et al (17) . Cavalcanti et al (20) explained complication by alveolar overdistention and pneumothorax produced by unnecessary higher PEEP.…”

Section: Discussionmentioning

confidence: 99%

Driving Pressure During Mechanical Ventilation of Acute Respiratory Distress Syndrome

Abdelhameed,

Al-Asmar,

Ali

et al. 2024

SJMS

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An International Overview and Meta-analysis for Using the Mechanical Ventilation in the Medical Treatment

Ngo

2021

Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering

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Methods for determining optimal positive end-expiratory pressure in patients undergoing invasive mechanical ventilation: a scoping review

Edginton,

Kruger,

Stelfox

et al. 2024

Can J Anesth/J Can Anesth

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Purpose There is significant variability in the application of positive end-expiratory pressure (PEEP) in patients undergoing invasive mechanical ventilation. There are numerous studies assessing methods of determining optimal PEEP, but many methods, patient populations, and study settings lack high-quality evidence. Guidelines make no recommendations about the use of a specific method because of equipoise and lack of high-quality evidence. We conducted a scoping review to determine which methods of determining optimal PEEP have been studied and what gaps exist in the literature. Source We searched five databases for primary research reports studying methods of determining optimal PEEP among adults undergoing invasive mechanical ventilation. Data abstracted consisted of the titration method, setting, study design, population, and outcomes. Principle findings Two hundred and seventy-one studies with 17,205 patients met the inclusion criteria, including 73 randomized controlled trials (RCTs) with 10,733 patients. We identified 22 methods. Eleven were studied with an RCT. Studies enrolled participants within an intensive care unit (ICU) (216/271, 80%) or operating room (55/271, 20%). Most ICU studies enrolled patients with acute respiratory distress syndrome (162/216, 75%). The three most studied methods were compliance (73 studies, 29 RCTs), imaging-based methods (65 studies, 11 RCTs), and use of PEEP-F I O 2 tables (52 studies, 20 RCTs). Among ICU RCTs, the most common primary outcomes were mortality or oxygenation. Few RCTs assessed feasibility of different methods ( n = 3). The strengths and limitations of each method are discussed. Conclusion Numerous methods of determining optimal PEEP have been evaluated; however, notable gaps remain in the evidence supporting their use. These include specific populations (normal lungs, patients weaning from mechanical ventilation) and using alternate outcomes (ventilator-free days and feasibility) and they present significant opportunities for future study. Study registration Open Science Framework ( https://osf.io/atzqc ); first posted, 19 July 2022. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-024-02871-6.

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Driving pressure-guided ventilation versus protective lung ventilation in ARDS patients: A prospective randomized controlled study

Cited by 4 publications

References 26 publications

Driving Pressure During Mechanical Ventilation of Acute Respiratory Distress Syndrome

Driving Pressure During Mechanical Ventilation of Acute Respiratory Distress Syndrome

An International Overview and Meta-analysis for Using the Mechanical Ventilation in the Medical Treatment

Methods for determining optimal positive end-expiratory pressure in patients undergoing invasive mechanical ventilation: a scoping review

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