Driving pressure in obese patients with acute respiratory distress syndrome: one size fits all?

Vianna, Felipe Souza Lima; Pfeilsticker, Flavia Julie do Amaral; Neto, Ary Serpa

doi:10.21037/jtd.2018.09.31

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…Due to the variability of these values, a true reflection of ∆P cannot be obtained accurately. In obese patients, transpulmonary ∆P is more reliable, but more studies are required to better explain these assumptions[ 54 ]. De Jong et al [ 55 ] studied the relationship between ∆P during the first day of ventilation and 90-d mortality in 100 obese patients and 262 non-obese patients with ARDS but found no association between ∆P and mortality in obese patients.…”

Section: ∆P In Special Populationsmentioning

confidence: 99%

Driving pressure in mechanical ventilation: A review

Zaidi,

Shaikh,

Khan

et al. 2024

World J Crit Care Med

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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.

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Section: ∆P In Special Populationsmentioning

confidence: 99%

Driving pressure in mechanical ventilation: A review

Zaidi,

Shaikh,

Khan

et al. 2024

World J Crit Care Med

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“…Since publication of the extended research of Dreyfuss et al [22], the main mechanism of VILI was considered to be pressure-related and resulted in pneumothorax, pneumomediastinum or gas embolism [22,23]. Subsequently, experimental data indicated that excessive lung strain caused by inappropriate tidal volumes (volotrauma) is the hallmark of pathophysiological mechanism of VILI [22][23][24]. Nowadays it is clear that both mechanisms are in close interaction, considering the fact that stress and strain are related through a proportionality constant represented by the tissue elastance of the lung [21,23,25].…”

Section: Barotrauma and Volotraumamentioning

confidence: 99%

“…The reported findings suggest that the available recommendation regarding mechanical ventilation for ARDS patients may not fit all groups of patients, such as obese patients [24]. However, there is limited data regarding current practice of mechanical ventilation in critically ill obese patients and most information comes from intraoperative clinical trials [29,33].…”

Section: Some Practical Aspectsmentioning

confidence: 99%

“…Jong et al [45] reported that driving pressure may not have an impact on obese patients mortality. Taking into account the elevated chest wall elastance, routinely monitoring oesophageal pressure as a surrogate for transpulmonary pressure should be considered [24,45]. Since this type of monitoring is not widely available, Ball et al [40] suggest that driving pressure of 17 cmH 2 O should be targeted.…”

Section: Some Practical Aspectsmentioning

confidence: 99%

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Ventilation in critically ill obese patients—Why it should be done differently?

2022

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Considering the increasing prevalence of obesity among the critically ill patient, mechanical ventilation of this type of patients has almost become a daily practice. However, no consensus regarding mechanical ventilation for obese patients has recently been published. Considering the particular pathophysiological features of respiratory system in obese patients, the risk of ventilator induced lung injury (VILI) is highly elevated. This narrative review aims to present the constrains related to mechanical ventilation in obese patients, as well as the features that predispose them to VILI. Moreover, the effects every determinant incriminated in VILI were described with application on the pathophysiological features of obese patients. Increased emphasis was placed on the newly concept of ergotrauma as one of the main determinants of VILI. This is one of the first reviews dedicated to the effects of mechanical power and ergotrauma on mechanically ventilated patients with obesity. Moreover, increased attention was given to the impact of biotrauma related to VILI, considering that the new concept of “pre-conditioning cloud” related to obesity has recently emerged.

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“…[ 54 ] The role of ∆P in the context of obese patients, indeed, deserves deeper analysis. Obese patients are characterized by higher elastance of the chest wall; thus, the divergence between ∆P (an indirect measure of whole respiratory system compliance) and transpulmonary pressure may significantly raise in this setting [ 114 , 115 ]; due to this discrepancy, the respiratory system ∆P in obese patients seems to not be associated with lung injury [ 114 ], whereas it may represent a parameter to estimate the negative effect of ventilation on right ventricular function [ 116 ]. Notably, data regarding ∆P in obese patients are mostly derived from critically ill setting, and further studies are needed to describe its role in OR settings.…”

Section: Special Settings: Morbidity Obese Patientsmentioning

confidence: 99%

Management of Intraoperative Mechanical Ventilation to Prevent Postoperative Complications after General Anesthesia: A Narrative Review

Fogagnolo

Montanaro

Al-Husinat

et al. 2021

JCM

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Mechanical ventilation (MV) is still necessary in many surgical procedures; nonetheless, intraoperative MV is not free from harmful effects. Protective ventilation strategies, which include the combination of low tidal volume and adequate positive end expiratory pressure (PEEP) levels, are usually adopted to minimize the ventilation-induced lung injury and to avoid post-operative pulmonary complications (PPCs). Even so, volutrauma and atelectrauma may co-exist at different levels of tidal volume and PEEP, and therefore, the physiological response to the MV settings should be monitored in each patient. A personalized perioperative approach is gaining relevance in the field of intraoperative MV; in particular, many efforts have been made to individualize PEEP, giving more emphasis on physiological and functional status to the whole body. In this review, we summarized the latest findings about the optimization of PEEP and intraoperative MV in different surgical settings. Starting from a physiological point of view, we described how to approach the individualized MV and monitor the effects of MV on lung function.

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Driving pressure in obese patients with acute respiratory distress syndrome: one size fits all?

Cited by 5 publications

References 25 publications

Driving pressure in mechanical ventilation: A review

Driving pressure in mechanical ventilation: A review

Ventilation in critically ill obese patients—Why it should be done differently?

Management of Intraoperative Mechanical Ventilation to Prevent Postoperative Complications after General Anesthesia: A Narrative Review

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