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.

Keywords: Driving pressure; Acute respiratory distress syndrome; Mortality; Positive end-expiratory pressure; Ventilator induced lung injury; Mechanical ventilation

Core Tip: Driving pressures (∆P) of < 15 have demonstrated the greatest benefit in mortality. It is most utilized in patients with acute respiratory distress syndrome (ARDS). Some large-scale randomized controlled trials are currently underway; their results will dictate the outcomes of certain ∆Ps under specialized conditions, such as the feasibility of reducing ∆P in ARDS patients on mechanical ventilation and the impact of lateral positioning on ∆P. It is clear, however, that careful implementation of ∆Ps can greatly improve outcomes.