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Copyright ©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
Table 1 Findings from clinical studies regarding driving pressure
Population
Ref.
Study design
Sample
Findings
ARDSBlondonnet et al[40]Prospective cohort; secondary analysis221 patients with at least 1 risk factor for ARDS15% developed ARDS within 7 d who had higher baseline ΔP
ARDSGuerin et al[7]2 randomized controlled trials787 patientsDP was more strongly associated with survival as compared to PEEP and tidal volume in ARDS patients
Secondary analysisPEEP and Tidal volume were not associated with death in any model
ARDSRomano et al[41]Pilot randomized, controlled, nonblinded trial31 patients with ARDS on invasive mechanical ventilation with a driving pressure of ≥ 13 cm H2ODP and tidal volumes were lower in the driving pressure-limited group as opposed to the conventional group, although there was no effect on outcomes
ARDSChiumello et al[2]Prospective cohort150 patientsAt 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
ARDSAmato et al[3]Meta-analysis of 9 RCTs3562 patients in the ICUARDS 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
ARDSBellani et al[27]Prospective cohort459 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
ARDSBellani et al[29]Retrospective cohort study154 patientsDP 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
ARDSUrner et al[32]Registry-based cohort study9 ICUs; 12865 patients requiring > 24 h of mechanical ventilationMortality was 18.1% with DP < 15 cm H2O compared with 20.1% under usual care
ARDSHaudebourg et al[11]Prospective cohort51 adult patientsThe 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
ECMOGupta et al[44]Retrospective cohort192 patients47% 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
ARDSDel Sorbo et al[47]Randomized crossover physiologic study10 patientsA linear relationship was seen between the change in driving pressure and the concentration of IL-6
ECMOMagunia et al[45]Retrospective cohort105 patients undergoing VV-ECMOΔP was greater than 15 mbar in non-survivors
ECMO and ARDSChiu et al[46]Retrospective cohort158 patients with severe ARDS on ECMOAfter 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
SurgicalBlank et al[49]Retrospective cohort1019 patients undergoing thoracic surgery with ventilationDP was a risk factor for overall post-operative morbidity
SurgicalNeto et al[50]Meta-analysis17 randomized controlled trials, including 2250 post-operative patientsDP 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 Cohort4694 patients10.9% experienced pulmonary complications
Surgical Park et al[52]Double-blind, randomized, controlled trial292 patientsMelbourne Group Scale of at least 4 occurred in 8 of 145 patients in the DP group
Li et al[71]Systematic review and meta-analysis640 patientsThe incidence of PPCS was lower and the compliance of the respiratory system was higher in the DP-oriented group during OLV
ObesityDe Jong et al[55]Retrospective cohort72% non-obese and 28% obese patientsThe 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
PregnantLapinsky et al[60]Prospective cohortIn 21 ICUs 69 patients requiring invasive mechanical ventilation, and 47 patients delivered while on the ventilatorSurvivors 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
PediatricRauf et al[9]Retrospective cohort study380 children in the ICUChildren in the group with low ΔP (< 15 cm H2O) had significantly lower median duration of ventilation, length of stay and ventilator-free days
ARDSYehya et al[61]Prospective cohort study544 children DP was not an independent predictor of mortality
PediatricSchelven et al[13]Prospective cohort study (secondary analysis)222 childrenHigher disease severity, MV indication, and increase in extubation time in patients with higher DPs
Heart FailureYang et al[67]Retrospective cohort632 patients DP was independently associated with in-hospital mortality
No ARDSSchmidt et al[10]Retrospective cohort622 patientsΔP was not independently associated with hospital mortality