Driving Pressure and Transpulmonary Pressure How Do We Guide Safe Mechanical Ventilation?

Concern over the potential for lung injury due to mechanical ventilation has fueled investigations on lung protection in the operating room.1 –3 Based on the intensive care literature,4 tidal volume (VT) and positive end-expiratory pressure (PEEP) settings have been the focus of intraoperative clinical trials.1 –3 Recent results in acute respiratory distress syndrome (ARDS)5 and surgical patients6,7 have suggested that the benefits associated with VT and PEEP settings are mediated by driving pressures. As our understanding of the physical and biologic effects of mechanical ventilation evolves, the concepts of driving pressure and transpulmonary pressure have been increasingly used to quantify the mechanical forces acting over the lungs during mechanical ventilation and to guide clinical care. In this perspective, we discuss the definition of those concepts, their measurement in the clinical setting, their interpretation, and their use in typical scenarios.

Source: Anesthesiology - June 18, 2019 Category: Anesthesiology Source Type: research