Altering the mechanical scenario to decrease the driving pressure

Crit Care. 2015 Sep 21;19(1):342. 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.

Publication types

  • Letter

MeSH terms

  • Humans
  • Lung / physiopathology*
  • Positive-Pressure Respiration / methods*
  • Positive-Pressure Respiration / mortality
  • Pressure / adverse effects*
  • Respiration, Artificial / adverse effects
  • Respiration, Artificial / methods*
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / physiopathology*
  • Ventilators, Mechanical*