The future of driving pressure: a primary goal for mechanical ventilation?

Aoyama, Hiroko; Yamada, Yosuke; Fan, Eddy

doi:10.1186/s40560-018-0334-4

Cited by 32 publications

(25 citation statements)

References 18 publications

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“…We are reassured that our data supports an association between tidal volume and mortality in ARDS patients and supports the recent meta-analysis confirming the association of ΔP and mortality in ARDS patients [11]. While the current state of evidence is not mature enough to recommend ΔP as a management strategy for ARDS [26], our data demonstrates no justification at this time to recommend it as a management strategy for non-ARDS patients.…”

Section: Discussionsupporting

confidence: 60%

Driving pressure is not associated with mortality in mechanically ventilated patients without ARDS

et al. 2019

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Background: In patients with acute respiratory distress syndrome (ARDS), low tidal volume ventilation has been associated with reduced mortality. Driving pressure (tidal volume normalized to respiratory system compliance) may be an even stronger predictor of ARDS survival than tidal volume. We sought to study whether these associations hold true in acute respiratory failure patients without ARDS. Methods: This is a retrospectively cohort analysis of mechanically ventilated adult patients admitted to ICUs from 12 hospitals over 2 years. We used natural language processing of chest radiograph reports and data from the electronic medical record to identify patients who had ARDS. We used multivariable logistic regression and generalized linear models to estimate associations between tidal volume, driving pressure, and respiratory system compliance with adjusted 30-day mortality using covariates of Acute Physiology Score (APS), Charlson Comorbidity Index (CCI), age, and PaO 2 /FiO 2 ratio. Results: We studied 2641 patients; 48% had ARDS (n = 1273). Patients with ARDS had higher mean APS (25 vs. 23, p < .001) but similar CCI (4 vs. 3, p = 0.6) scores. For non-ARDS patients, tidal volume was associated with increased adjusted mortality (OR 1.18 per 1 mL/kg PBW increase in tidal volume, CI 1.04 to 1.35, p = 0.010). We observed no association between driving pressure or respiratory compliance and mortality in patients without ARDS. In ARDS patients, both ΔP (OR1.1, CI 1.06-1.14, p < 0.001) and tidal volume (OR 1.17, CI 1.04-1.31, p = 0.007) were associated with mortality. Conclusions: In a large retrospective analysis of critically ill non-ARDS patients receiving mechanical ventilation, we found that tidal volume was associated with 30-day mortality, while driving pressure was not.

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Section: Discussionsupporting

confidence: 60%

Driving pressure is not associated with mortality in mechanically ventilated patients without ARDS

et al. 2019

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“…15 Thus, we aimed to investigate the effect of PEEP on SVV by adjusting various preload conditions and driving pressure, which is PIP minus PEEP, to differentiate the influence of PEEP and driving pressure with pressure-controlled mode under mechanical ventilations in animal experiment. 16…”

mentioning

confidence: 99%

The effect of positive‐end‐expiratory pressure on stroke volume variation: An experimental study in dogs

Nakashima

Kawazoe

Iseri

et al. 2020

Clin Exp Pharma Physio

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Stroke volume variation (SVV) may be affected by ventilation settings. However, it is unclear whether positive‐end‐expiratory pressure (PEEP) affects SVV independently of the effect of driving pressure. We aimed to investigate the effect of driving pressure and PEEP on SVV under various preload conditions using beagle dogs as the animal model. We prepared three preload model, baseline, mild and moderate haemorrhage model. Mild and moderate haemorrhage models were created in nine anaesthetized, mechanically ventilated dogs by sequentially removing 10 mL/kg, and then an additional 10 mL/kg of blood, respectively. We measured cardiac output, stroke volume (SV), SVV, heart rate, central venous pressure, pulmonary capillary wedge pressure and the mean arterial pressure under varying ventilation settings. Peak inspiratory pressure (PIP) was incrementally increased by 4 cmH2O, from 9 cmH2O to 21 cmH2O, under PEEP values of 4, 8, and 12 cmH2O. The driving pressure did not significantly decrease SV under each preload condition and PEEP; however, significantly increased SVV. In contrast, the increased PEEP decreased SV and increased SVV under each preload condition and driving pressure, but these associations were not statistically significant. According to multiple regression analysis, an increase in PEEP and decrease in preload significantly decreased SV (P < .05). In addition, an increase in the driving pressure and decrease in preload significantly increased SVV (P < .05). Driving pressure had more influence than PEEP on SVV.

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“…18 Although driving pressure (plateau pressure À PEEP) > 15 cm H 2 O has been shown to be associated with higher mortality in subjects with ARDS, 19 the best limit has not been tested in a prospective randomized trial. 20 Despite the lack of prospective data, making changes to ventilator settings that maintain or even lower driving pressure may not have the same impact on lung stress or strain compared to changes that result in a significant increase in driving pressure (an increase is likely more injurious). However, the lowest driving pressure, or best compliance, does not always indicate that ventilation is the safest.…”

Section: Do We Need To Measure Lung Strain?mentioning

confidence: 99%

Lung Volume Measurement and Ventilation Distribution During Invasive Mechanical Ventilation

Piraino

2020

Respir Care

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Lung volume measurement performed during invasive mechanical ventilation can be used to determine functional residual capacity, changes in end-expiratory lung volume with the application of PEEP, and lung strain. However, many bedside measurements provide useful information without the use of specialized equipment. Ventilation distribution through the lung has traditionally been assessed with computed tomography, but more recently electrical impedance tomography has brought the ability to monitor this at the bedside, and without exposure to radiation. This review will describe techniques to measure lung volumes in the ICU and the relationship between lung strain, stress, and other measurements. This review will also discuss monitoring ventilation distribution at the bedside and the clinical assessment of regional compliance that this technology provides.

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The future of driving pressure: a primary goal for mechanical ventilation?

Cited by 32 publications

References 18 publications

Driving pressure is not associated with mortality in mechanically ventilated patients without ARDS

Driving pressure is not associated with mortality in mechanically ventilated patients without ARDS

The effect of positive‐end‐expiratory pressure on stroke volume variation: An experimental study in dogs

Lung Volume Measurement and Ventilation Distribution During Invasive Mechanical Ventilation

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