Bedside tip: How to measure driving pressure

30.08.2017
Author: Clinical Experts Group, Hamilton Medical, Reviewer: Paul Garbarini, David Grooms

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?

Driving pressure = Plateau pressure - Total PEEP

On a Hamilton Medical ventilator you can measure driving pressure in any ventilation mode, provided the patient is relaxed and making no inspiratory or expiratory effort, and there is no leakage from the ventilation circuit.

All you have to do is perform an end-inspiratory hold maneuver and then an end-expiratory hold for 3-5 seconds to measure the plateau pressure and total PEEP respectively.

End-inspiratory hold: Press the Tools button to open the Tools -> Hold window and select Insp hold, wait for 3 to 5 seconds, then select Insp hold or press the P&T knob again to deactivate the hold maneuver and close the window. The waveforms will freeze so you can check that plateau pressure is stable, then measure pressure at the end of the plateau using the cursor.

End-inspiratory hold in volume-control mode
End-inspiratory hold in ASV mode

End-expiratory hold: As above, but select Exp hold. Check that plateau pressure is stable, then measure pressure at the end of the plateau using the cursor.

End-expiratory hold in volume-control mode
End-expiratory hold in ASV mode

So driving pressure = inspiratory hold pressure (plateau pressure) - expiratory hold pressure (total PEEP).

References

  1. Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 2015; 372(8):747-55.
  2. Laffey JG, Bellani G, Pham T, Fan E, Madotto F, Bajwa EK, et al Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Med 2016; 42(12):1865-1876.
  3. Guérin C, Papazian L, Reignier J, Ayzac L, Loundou A, Forel JM; investigators of the Acurasys and Proseva trials. Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials. Crit Care 2016; 20(1):384.
  4. Chiumello D, Carlesso E, Brioni M, Cressoni M. Airway driving pressure and lung stress in ARDS patients. Crit Care 2016; 20:276.
  5. Baedorf Kassis E, Loring SH, Talmor D. Mortality and pulmonary mechanics in relation to respiratory system and transpulmonary driving pressures in ARDS. Intensive Care Med. 2016; 42(8):1206-13.
  6. Neto AS, Hemmes SN, Barbas CS, Beiderlinden M, Fernandez-Bustamante A, Futier E, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med 2016; 4(4):272-80. 

Related Articles

driving pressure, hold maneuver, end-expiratory, end-inspiratory, plateau pressure, PEEP, ASV
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Date of Printing: 18.10.2018
Disclaimer:
The content of this newsletter is for informational purposes only and is not intended to be a substitute for professional training or for standard treatment guidelines in your facility. Any recommendations made in this newsletter with respect to clinical practice or the use of specific products, technology or therapies represent the personal opinion of the author only, and may not be considered as official recommendations made by Hamilton Medical AG. Hamilton Medical AG provides no warranty with respect to the information contained in this newsletter and reliance on any part of this information is solely at your own risk.