Driving pressure decoded: Precision strategies in adult respiratory distress syndrome management

Abstract

Mechanical ventilation (MV) is an important strategy for improving the survival of patients with respiratory failure. However, MV is associated with aggravation of lung injury, with ventilator-induced lung injury (VILI) becoming a major concern. Thus, ventilation protection strategies have been developed to minimize complications from MV, with the goal of relieving excessive breathing workload, improving gas exchange, and minimizing VILI. By opting for lower tidal volumes, clinicians seek to strike a balance between providing adequate ventilation to support gas exchange and preventing overdistension of the alveoli, which can contribute to lung injury. Additionally, other factors play a role in optimizing lung protection during MV, including adequate positive end-expiratory pressure levels, to maintain alveolar recruitment and prevent atelectasis as well as careful consideration of plateau pressures to avoid excessive stress on the lung parenchyma.

Keywords: Driving pressure; Mechanical ventilation; Lung-protective ventilation strategies; Ventilator-induced lung injury

Core Tip: Mechanical ventilation (MV) is an important strategy that both prolong survival of patients and improve their prognosis. However, as MV is associated with ventilator-induced lung injury, strategies to prevent and minimize lung injury in patients are needed. Currently, an increasing number of studies have shown that lowering tidal pressure and increasing positive end-expiratory pressure are beneficial for preventing lung injury. Additionally, there is growing evidence that lowering driving pressure not only preserves gas exchange but also prevents lung injury. Regardless of the technique, there is consensus that strategies to prevent lung injury are needed, and that the ultimate goal of MV should be to provide adequate gas exchange while preventing lung injury.