Driving Pressure as an Outcome Indicator and Pre-Mortality Predictor in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome

Abstract

Background: Acute Respiratory Distress Syndrome (ARDS) is a life-threatening syndrome that affects mechanically ventilated individuals. Although lung-protective techniques prioritize low tidal volumes and plateau pressure, driving pressure (ΔP = plateau pressure – PEEP) has been identified as a more precise indicator of outcomes. This study assessed driving pressure as an outcome measure and a pre-mortality prognostic factor in ARDS.

Methods: A cross-sectional observational study utilizing questionnaires was performed with 120 ARDS patients admitted to ICUs. Demographic data, ventilatory parameters (tidal volume, PEEP, compliance, ΔP), and clinical outcomes were gathered by structured questionnaires and cross-verified with medical records. Patients were classified based on ΔP (≤14 cmH₂O vs >14 cmH₂O), and correlations with survival were examined by frequency distributions and chi-square testing.

Results: Patients exhibiting ΔP ≤14 cmH₂O demonstrated a markedly greater survival rate (71.8%) in contrast to those with ΔP >14 cmH₂O (28.2%). A good oxygenation index (PaO₂/FiO₂ >150) and lung compliance (>40 ml/cmH₂O) were linked to better results. Pre-mortality predictors were ΔP >14 cmH₂O (71.4% of non-survivors), poor compliance (66.7%), high PEEP (>15 cmH₂O, 42.9%), and tidal volume >6 ml/kg (38.1%).

Conclusion: Driving pressure is a dependable outcome measure and pre-mortality prediction in ARDS. Maintaining ΔP ≤14 cmH₂O, optimizing PEEP, and adhering to lung-protective ventilation strategies may improve survival.