Altering the mechanical scenario to decrease the driving pressure

作者：Borges Joao Batista^*; Hedenstierna Goran; Larsson Anders; Suarez Sipmann Fernando

来源：Critical Care, 2015, 19(1): 342.

DOI：10.1186/s13054-015-1063-x

Ventilator settings resulting in decreased driving pressure (Delta P) are positively associated with survival. How to further foster the potential beneficial mediator effect of a reduced Delta P? 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 Delta P.

• 出版日期2015-9-21