Altering the mechanical scenario to decrease the driving pressure

• Published in: Critical care (London, England) England), 2015-09, Vol.19 (1), p.342-342, Article 342
• Main Authors: Borges, João Batista, Hedenstierna, Göran, Larsson, Anders, Suarez-Sipmann, Fernando
• Format: Article
• Language: English
• Subjects: Anaesthesiology and Intensive Care; Anestesiologi och intensivvård; Critical care; Fysiologi; Humans; Letter; Lung - physiopathology; Physiology; Positive-Pressure Respiration - methods; Positive-Pressure Respiration - mortality; Pressure - adverse effects; Respiration, Artificial - adverse effects; Respiration, Artificial - methods; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - physiopathology; Respiratory therapy; Ventilators; Ventilators, Mechanical
• ISSN: 1364-8535; 1466-609X; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-015-1063-x

Ventilator settings resulting in decreased driving pressure (ΔP) are positively associated with survival. How to further foster the potential beneficial mediator effect of a reduced ΔP? One possibility is promoting the active modification of the lung's "mechanical scenario" by means of lung recruitment and positive end-expiratory pressure selection. By taking into account the individual distribution of the threshold-opening airway pressures to achieve maximal recruitment, a redistribution of the tidal volume from overdistended to newly recruited lung occurs. The resulting more homogeneous distribution of transpulmonary pressures may induce a relief of overdistension in the upper regions. The gain in lung compliance after a successful recruitment rescales the size of the functional lung, potentially allowing for a further reduction in ΔP.