From the Guidelines
Driving pressure in a mechanically ventilated patient is measured by calculating the difference between plateau pressure and positive end-expiratory pressure (PEEP), as recommended by the most recent study 1. To obtain this measurement, first perform an inspiratory hold maneuver to measure plateau pressure, which represents the static pressure in the respiratory system at end-inspiration. Then subtract the set PEEP value from this plateau pressure. For example, if a patient has a plateau pressure of 25 cmH2O and a PEEP of 5 cmH2O, the driving pressure would be 20 cmH2O.
Key Considerations
- This calculation is important because driving pressure reflects the stress applied to the lungs during mechanical ventilation and is a key component of lung-protective ventilation strategies.
- Lower driving pressures (ideally below 15 cmH2O) are associated with reduced ventilator-induced lung injury and improved patient outcomes, as suggested by previous studies 1.
- Clinicians should routinely monitor driving pressure alongside other ventilation parameters such as tidal volume and respiratory rate to optimize mechanical ventilation and minimize potential harm to the patient's lungs.
Clinical Application
- The measurement of driving pressure can be used to guide the adjustment of PEEP and other ventilation parameters to minimize lung injury and improve patient outcomes.
- The use of electrical impedance tomography (EIT) can also help to individualize PEEP setting and minimize ventilator-induced lung injury, as discussed in the recent study 1.
- It is essential to consider the patient's individual condition and response to mechanical ventilation when interpreting driving pressure measurements and adjusting ventilation parameters.
From the Research
Measuring Driving Pressure
To measure driving pressure in a mechanically ventilated patient, the following parameters should be considered:
- The difference between the respiratory system inspiratory plateau pressure and positive end-expiratory pressure (PEEP) 2, 3
- Transpulmonary driving pressure, which can be measured using an esophageal pressure measurement catheter connected to the ventilator 4
- Tidal volume and PEEP should be adjusted based on the observed end-inspiratory and end-expiratory transpulmonary pressures, aiming to maintain a transpulmonary driving pressure below 15 cmH2O during mechanical ventilation 4
Key Parameters
Some key parameters to monitor when measuring driving pressure include:
- Intrinsic PEEP
- Peak (Ppeak) and plateau (Pplat) pressures
- Mechanical energy
- Mechanical power
- Intensity
- Pressure generated 100 ms after onset of inspiratory effort (P0.1)
- Pressure-time product per minute (PTP/min) 2
Clinical Studies
Clinical studies have shown that lung-protective mechanical ventilation using transpulmonary driving pressure titrated PEEP can effectively improve lung function, reduce mechanical ventilation duration and hospital stay, and enhance survival outcomes in patients with Acute Respiratory Distress Syndrome (ARDS) 4 Additionally, driving pressure has been shown to be a core therapeutic component of mechanical ventilation, and varying levels of driving pressure have been employed depending on the type of underlying pathology and severity of injury 5