Driving pressure and acute respiratory distress syndrome in critically ill patients

Respirology. 2019 Feb;24(2):137-145. doi: 10.1111/resp.13394. Epub 2018 Sep 5.


Background and objective: Elevated driving pressure (ΔP) may be associated with increased risk of acute respiratory distress syndrome (ARDS) in patients admitted via the emergency department and with post-operative pulmonary complications in surgical patients. This study investigated the association of higher ΔP with the onset of ARDS in a high-risk, intensive care unit (ICU) population.

Methods: This is a secondary analysis of a prospective multicentre observational study. Data for this ancillary study were obtained from intubated adult patients with at least one ARDS risk factor upon ICU admission enrolled in a previous multicentre observational study. Patients were followed up for the development of ARDS within 7 days (primary outcome). Univariate and multivariate analyses tested the association between ΔP (measured at ICU admission (baseline) or 24 h later (day 1)) and the development of ARDS.

Results: A total of 221 patients were included in this study, among whom 34 (15%) developed ARDS within 7 days. These patients had higher baseline ΔP than those who did not (mean ± SD: 12.5 ± 3.1 vs 9.8 ± 3.4 cm H2 O, respectively, P = 0.0001). The association between baseline ΔP and the risk of developing ARDS was robust to adjustment for baseline tidal volume, positive-end expiratory pressure, illness severity, serum lactate and sepsis, pneumonia, severe trauma and shock as primary ARDS risk factors (odds ratio: 1.20; 95% CI: 1.03-1.41; P = 0.02). The same results were found with day 1 ΔP.

Conclusion: Among at-risk ICU patients, higher ΔP may identify those who are more likely to develop ARDS.

Trial registration: ClinicalTrials.gov NCT02070536.

Keywords: acute respiratory distress syndrome; driving pressure; intensive care unit; mechanical ventilation; risk prediction.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Correlation of Data
  • Critical Care / methods
  • Critical Illness / therapy*
  • Female
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Positive-Pressure Respiration* / adverse effects
  • Positive-Pressure Respiration* / methods
  • Respiration, Artificial* / adverse effects
  • Respiration, Artificial* / methods
  • Respiratory Distress Syndrome / etiology*
  • Risk Adjustment
  • Risk Factors

Associated data

  • ClinicalTrials.gov/NCT02070536