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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

Airway driving pressure and lung stress in ARDS patients

Authors: Davide Chiumello, Eleonora Carlesso, Matteo Brioni, Massimo Cressoni

Published in: Critical Care | Issue 1/2016

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Abstract

Background

Lung-protective ventilation strategy suggests the use of low tidal volume, depending on ideal body weight, and adequate levels of PEEP. However, reducing tidal volume according to ideal body weight does not always prevent overstress and overstrain. On the contrary, titrating mechanical ventilation on airway driving pressure, computed as airway pressure changes from PEEP to end-inspiratory plateau pressure, equivalent to the ratio between the tidal volume and compliance of respiratory system, should better reflect lung injury. However, possible changes in chest wall elastance could affect the reliability of airway driving pressure. The aim of this study was to evaluate if airway driving pressure could accurately predict lung stress (the pressure generated into the lung due to PEEP and tidal volume).

Methods

One hundred and fifty ARDS patients were enrolled. At 5 and 15 cmH2O of PEEP, lung stress, driving pressure, lung and chest wall elastance were measured.

Results

The applied tidal volume (mL/kg of ideal body weight) was not related to lung gas volume (r 2 = 0.0005 p = 0.772). Patients were divided according to an airway driving pressure lower and equal/higher than 15 cmH2O (the lower and higher airway driving pressure groups). At both PEEP levels, the higher airway driving pressure group had a significantly higher lung stress, respiratory system and lung elastance compared to the lower airway driving pressure group. Airway driving pressure was significantly related to lung stress (r 2 = 0.581 p < 0.0001 and r 2 = 0.353 p < 0.0001 at 5 and 15 cmH2O of PEEP). For a lung stress of 24 and 26 cmH2O, the optimal cutoff value for the airway driving pressure were 15.0 cmH2O (ROC AUC 0.85, 95 % CI = 0.782–0.922); and 16.7 (ROC AUC 0.84, 95 % CI = 0.742–0.936).

Conclusions

Airway driving pressure can detect lung overstress with an acceptable accuracy. However, further studies are needed to establish if these limits could be used for ventilator settings.
Appendix
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Metadata
Title
Airway driving pressure and lung stress in ARDS patients
Authors
Davide Chiumello
Eleonora Carlesso
Matteo Brioni
Massimo Cressoni
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1446-7

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