Driving pressure: pitfalls of methods that do not use esophageal pressure measurement. Author’s reply

Excerpt

We thank Ono for his interest and comments on our manuscript [1]. In our previous article, we recognize that, in terms of assessing the risk of ventilator-induced lung injury, we should measure transpulmonary driving pressure (ΔP_L) [2]. This is because the driving pressure of the respiratory system (ΔP) also considers the amount of pressure required to expand the chest wall. However, it is also true that assuming that the elastance of the chest wall may not significantly change in majority of patients during their intensive care unit (ICU) admission, any change in ΔP may reflect a change in ΔP_L. Therefore, changes in ΔP could be used to monitor the evolution of lung injury and to assess the response to different clinical interventions, such as changes in the ventilator settings. …