So, last year Amato et al published a paper on Driving Pressure:

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome

It contained an incredibly interesting theory--driving pressure may be a much better measure of lung protection than Plateau Pressure. Driving pressure is Vt/Crs (Vt being tidal volume based on ideal body weight and Crs is the compliance of the respiratory system. In patients who are not spontaneously breathing, driving pressure could also be calculated by Plateau Pressure minus PEEP. These graphs explain how it can be both:

from Brower R.

from JE Kenny

Based on the study, a driving pressure < 15 seems associated with lower mortality, even in patients with elevated plateau pressures. Conversely, patients with Plats < 30, but driving pressures >=15 still seem to be at risk. The study also offers a possible explanation for why the ARDSnet higher PEEP trials did not show benefit--higher PEEP only seems to help if it leads to reductions rather than elevations of the driving pressure (due to lung recruitment).

In this episode, I dicuss the logistics of Driving Pressure with Dr. Roy Brower, senior author of the study. Dr. Brower is a professor of Medicine and Medical Director of the MICU at the Johns Hopkins Hospital. He has over 150 publications, numerous national teaching awards and is the most recent recipient of the ATS Life Time Achievement Award (intro cribbed from MCCP).

After listening to the show, if you want to hear more of the underpinnings of driving pressure, listen to Dr. Browers lecture on the amazing Maryland CC Project:

Brower on Driving Pressure

Additional Reading

* From LitFL CCC Project

* ICU Physiology by JE Kenny

* Gattinoni on PEEP Selection

Now on to the Podcast...