TY - JOUR
T1 - Do more injured lungs need more protection? Let’s test it
AU - Bihari, Shailesh
AU - Thompson, B. Taylor
AU - Bersten, Andrew D.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Driving pressure, calculated as the difference between plateau pressure and positive end-expiratory pressure (PEEP) during mechanical ventilation in a relaxed subject, has an independent association with the risk of death in patients with acute respiratory distress syndrome (ARDS) (1, 2), suggesting that interventions in these patients such as PEEP titration are beneficial only if associated with a decrease in driving pressure. Lung computed tomography demonstrating heterogonous aeration in ARDS typically reveals dependent nonaerated lung, which is central to both our current understanding of ventilation strategies (3) and the typical increase in respiratory system stiffness (static elastance) estimated as the driving pressure divided by the Vt. Perhaps readers will be more familiar with compliance (the inverse of elastance); both static respiratory system elastance and compliance are largely influenced by the volume of aerated lung. As both the stress and strain resulting in ventilation-induced lung injury reflect Vt and end-expiratory lung volume, targeting driving pressure makes sense, as driving pressure, in effect, scales Vt to the magnitude of the reduced lung volume for a given patient with ARDS.
AB - Driving pressure, calculated as the difference between plateau pressure and positive end-expiratory pressure (PEEP) during mechanical ventilation in a relaxed subject, has an independent association with the risk of death in patients with acute respiratory distress syndrome (ARDS) (1, 2), suggesting that interventions in these patients such as PEEP titration are beneficial only if associated with a decrease in driving pressure. Lung computed tomography demonstrating heterogonous aeration in ARDS typically reveals dependent nonaerated lung, which is central to both our current understanding of ventilation strategies (3) and the typical increase in respiratory system stiffness (static elastance) estimated as the driving pressure divided by the Vt. Perhaps readers will be more familiar with compliance (the inverse of elastance); both static respiratory system elastance and compliance are largely influenced by the volume of aerated lung. As both the stress and strain resulting in ventilation-induced lung injury reflect Vt and end-expiratory lung volume, targeting driving pressure makes sense, as driving pressure, in effect, scales Vt to the magnitude of the reduced lung volume for a given patient with ARDS.
KW - PEEP
KW - acute respiratory distress syndrome (ARDS)
KW - Driving pressure
KW - lung computed tomography
UR - http://www.scopus.com/inward/record.url?scp=85107526543&partnerID=8YFLogxK
U2 - 10.1164/rccm.202101-0154ED
DO - 10.1164/rccm.202101-0154ED
M3 - Editorial
C2 - 33560936
AN - SCOPUS:85107526543
SN - 1073-449X
VL - 203
SP - 1334
EP - 1336
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 11
ER -