A caveat on the computation of plateau pressures is that they cannot be presumed to represent end-inspiratory alveolar pressures when end-inspiratory flows are not zero, indicating lack of equilibration between airway and alveolar pressures. Accordingly, in the absence of respiratory muscle effort by the patient, driving pressure is the pressure above PEEP applied to the entire respiratory system to achieve tidal ventilation. ![]() 16 Plateau pressure is measured at the end of an inspiratory pause during volume-controlled constant flow ventilation and at the end of inspiration during pressure-controlled ventilation. What Are Strain and Stress and How Do They Apply to Mechanical Ventilation and Ventilator-induced Lung Injury?ĭriving pressure is defined as plateau pressure minus PEEP ( fig. In this perspective, we discuss the definition of those concepts, their measurement in the clinical setting, their interpretation, and their use in typical scenarios. As our understanding of the physical and biologic effects of mechanical ventilation evolves, the concepts of driving pressure and transpulmonary pressure have been increasingly used to quantify the mechanical forces acting over the lungs during mechanical ventilation and to guide clinical care. 1–3 Recent results in acute respiratory distress syndrome (ARDS) 5 and surgical patients 6, 7 have suggested that the benefits associated with V T and PEEP settings are mediated by driving pressures. 1–3 Based on the intensive care literature, 4 tidal volume (V T) and positive end-expiratory pressure (PEEP) settings have been the focus of intraoperative clinical trials. ![]() ![]() Concern over the potential for lung injury due to mechanical ventilation has fueled investigations on lung protection in the operating room.
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