ARDS is characterized by lung collapse and consolidation leaving just a small portion of aerated lung remaining, which is at risk of ventilator-induced lung injuries (baby-lung concept). According to the results of the LUNG SAFE study, ARDS occurs in 10% of all patients admitted to the ICU and has a hospital mortality of 40%. The same study also included an analysis to determine which factors may present a risk in terms of mortality, with the focus on ventilator settings. Findings from this study confirm the relevance of driving pressure in a clinical setting and, in particular, of the level of driving pressure in certain subgroups. Other evidence has shown driving pressure to be the ventilator variable associated most strongly with hospital survival. Driving pressure is calculated as the difference between plateau pressure and total PEEP, and can be measured quite easily using end-inspiratory and end-expiratory occlusions respectively.
Tip for the bedside: How to measure driving pressure?
Airway driving pressure is associated with clinical outcomes in ARDS, post-surgical, and normal-lung patients, and is a measure of the strain applied to the respiratory system and the risk of ventilator-induced lung injuries. Evidence suggests we should keep driving pressure below 14 cmH2O. But how can we measure it?
Fact of the day
After years of disunity between Upper and Lower Egypt, the two countries were reconciled in around 3100 B.C. The windpipe was chosen as a symbol for this reconciliation as it represents unity. Artifacts often depict the Sema hieroglyph (windpipe and lungs) with the Lotus (Upper Egypt) and Papyrus (Lower Egpyt) on either side.
Product news: Did you know...
...that Adaptive Support Ventilation (ASV) is a ventilation mode for all passive and spontaneously breathing patients, which automatically adjusts ventilation to lung mechanics and ensures the most favorable breathing pattern for the patient. The latest version, ASV 1.1, incorporates settings based on the most recent recommendations with respect to tidal volumes and driving pressure, and is a standard feature on all new Hamilton Medical ventilators.