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©The Author(s) 2024.
World J Crit Care Med. Mar 9, 2024; 13(1): 88385
Published online Mar 9, 2024. doi: 10.5492/wjccm.v13.i1.88385
Published online Mar 9, 2024. doi: 10.5492/wjccm.v13.i1.88385
Population | Ref. | Study design | Sample | Findings |
ARDS | Blondonnet et al[40] | Prospective cohort; secondary analysis | 221 patients with at least 1 risk factor for ARDS | 15% developed ARDS within 7 d who had higher baseline ΔP |
ARDS | Guerin et al[7] | 2 randomized controlled trials | 787 patients | DP was more strongly associated with survival as compared to PEEP and tidal volume in ARDS patients |
Secondary analysis | PEEP and Tidal volume were not associated with death in any model | |||
ARDS | Romano et al[41] | Pilot randomized, controlled, nonblinded trial | 31 patients with ARDS on invasive mechanical ventilation with a driving pressure of ≥ 13 cm H2O | DP and tidal volumes were lower in the driving pressure-limited group as opposed to the conventional group, although there was no effect on outcomes |
ARDS | Chiumello et al[2] | Prospective cohort | 150 patients | At ICU admission, non-surviving patients had a higher arterial carbon dioxide compared to survivors; The transpulmonary driving pressure was significantly related to the airway DP; The transpulmonary driving pressure was significantly related to lung stress |
ARDS | Amato et al[3] | Meta-analysis of 9 RCTs | 3562 patients in the ICU | ARDS patients with elevated DP of 15cm H2O were positively associated with higher mortality; A DP of less than 15 cm H2O was a safe threshold to guide ventilation in ARDS patients and decrease mortality |
ARDS | Bellani et al[27] | Prospective cohort | 459 ICUs; 12906 patients | High peak pressures, higher plateau pressures, high driving pressures of > 14 cm H2O, and low peep were associated with increased mortality; There was a direct relationship between both plateau and DP and mortality |
ARDS | Bellani et al[29] | Retrospective cohort study | 154 patients | DP was higher, compliance was lower and peak pressure was similar, in non-survivors versus survivors; Lower respiratory system compliance and higher driving pressure were each independently associated with an increased risk of death |
ARDS | Urner et al[32] | Registry-based cohort study | 9 ICUs; 12865 patients requiring > 24 h of mechanical ventilation | Mortality was 18.1% with DP < 15 cm H2O compared with 20.1% under usual care |
ARDS | Haudebourg et al[11] | Prospective cohort | 51 adult patients | The change from PBW to ∆P-guided ventilation was thus accompanied by an overall increase in tidal volume from 6.1 mL/kg PBW to 7.7 mL/kg PBW (6.2-8.7), while the respiratory rate was decreased from 29 breaths/min to 21 breaths/min |
ECMO | Gupta et al[44] | Retrospective cohort | 192 patients | 47% had a decrease in DP, whereas 32 46% had an increase in DP, and 7% had no change in DP after ECMO initiation. Those with an increase in DP had a significantly longer stay on ECMO than those without; Higher DP 24 h after ECMO initiation was associated with an increase in 30-d mortality |
ARDS | Del Sorbo et al[47] | Randomized crossover physiologic study | 10 patients | A linear relationship was seen between the change in driving pressure and the concentration of IL-6 |
ECMO | Magunia et al[45] | Retrospective cohort | 105 patients undergoing VV-ECMO | ΔP was greater than 15 mbar in non-survivors |
ECMO and ARDS | Chiu et al[46] | Retrospective cohort | 158 patients with severe ARDS on ECMO | After ECMO initiation, non-survivors had significantly higher dynamic DP until day 7 than survivors; Acute Physiology and Chronic Health Evaluation II score, ARDS duration before ECMO and mean driving pressure were independently associated with mortality |
Surgical | Blank et al[49] | Retrospective cohort | 1019 patients undergoing thoracic surgery with ventilation | DP was a risk factor for overall post-operative morbidity |
Surgical | Neto et al[50] | Meta-analysis | 17 randomized controlled trials, including 2250 post-operative patients | DP was associated with the development of postoperative pulmonary complications; An increase in the level of PEEP that resulted in an increase in DP was associated with more postoperative pulmonary complications |
Surgical | Mathis et al[51] | Observational Cohort | 4694 patients | 10.9% experienced pulmonary complications |
Surgical | Park et al[52] | Double-blind, randomized, controlled trial | 292 patients | Melbourne Group Scale of at least 4 occurred in 8 of 145 patients in the DP group |
Li et al[71] | Systematic review and meta-analysis | 640 patients | The incidence of PPCS was lower and the compliance of the respiratory system was higher in the DP-oriented group during OLV | |
Obesity | De Jong et al[55] | Retrospective cohort | 72% non-obese and 28% obese patients | The mortality rate at day 90 was 47% in the non-obese and 46% in the obese patients; In obese patients, driving pressure at day 1 was not significantly different |
Pregnant | Lapinsky et al[60] | Prospective cohort | In 21 ICUs 69 patients requiring invasive mechanical ventilation, and 47 patients delivered while on the ventilator | Survivors had an average DP of < 14 cm H2O; Maternal mortality rate of 17.5 %, and perinatal mortality rate of 15.4%; The mortality rate was lower than in the general COVID-19 population |
Pediatric | Rauf et al[9] | Retrospective cohort study | 380 children in the ICU | Children in the group with low ΔP (< 15 cm H2O) had significantly lower median duration of ventilation, length of stay and ventilator-free days |
ARDS | Yehya et al[61] | Prospective cohort study | 544 children | DP was not an independent predictor of mortality |
Pediatric | Schelven et al[13] | Prospective cohort study (secondary analysis) | 222 children | Higher disease severity, MV indication, and increase in extubation time in patients with higher DPs |
Heart Failure | Yang et al[67] | Retrospective cohort | 632 patients | DP was independently associated with in-hospital mortality |
No ARDS | Schmidt et al[10] | Retrospective cohort | 622 patients | ΔP was not independently associated with hospital mortality |
- Citation: Zaidi SF, Shaikh A, Khan DA, Surani S, Ratnani I. Driving pressure in mechanical ventilation: A review. World J Crit Care Med 2024; 13(1): 88385
- URL: https://www.wjgnet.com/2220-3141/full/v13/i1/88385.htm
- DOI: https://dx.doi.org/10.5492/wjccm.v13.i1.88385