Purpose of review Assess the most recent studies using driving pressure (DP) as a monitoring technique under mechanical ventilation and describe the technical challenges associated with its measurement. Recent findings DP is consistently associated with survival in acute respiratory failure and acute respiratory distress syndrome (ARDS) and can detect patients at higher risk of ventilator-induced lung injury. Its measurement can be challenged by leaks and ventilator dyssynchrony, but is also feasible under pressure support ventilation. Interestingly, an aggregated summary of published results suggests that its level is on average slightly lower in patients with coronavirus disease-19 induced ARDS than in classical ARDS. Summary The DP is easy to obtain and should be incorporated as a minimal monitoring technique under mechanical ventilation.

Driving pressure monitoring during acute respiratory failure in 2020.

Background: Driving pressure (Delta Prs) across the respiratory system a is suggested as the strongest predictor of hospital mortality in a patients with acute respiratory distress syndrome (ARDS). We wonder a whether this result is related to the range of tidal volume (VT). a Therefore, we investigated.Prs in two trials in which strict a lungprotective mechanical ventilation was applied in ARDS. Our working a hypothesis was that.Prs is a risk factor for mortality just like a compliance (Crs) or plateau pressure (Pplat, rs) of the respiratory a system. a Methods: We performed secondary analysis of data from 787 ARDS patients a enrolled in two independent randomized controlled trials evaluating a distinct adjunctive techniques while they were ventilated as in the low a VT arm of the ARDSnet trial. For this study, we used VT, positive a end-expiratory pressure (PEEP), Pplat, rs, Crs,Delta Prs, and a respiratory rate recorded 24 hours after randomization, and compared a them between survivors and nonsurvivors at day 90. Patients were a followed for 90 days after inclusion. Cox proportional hazard modeling a was used for mortality at day 90. If colinearity between.Delta Prs, Crs, a and Pplat, rs was verified, specific Cox models were used for each of a them. a Results: Both trials enrolled 805 patients of whom 787 had day-1 data a available, and 533 of these survived. In the univariate analysis,Delta a Prs averaged 13.7 +/- 3.7 and 12.8 +/- 3.7 cmH2O (P = 0.002) in a nonsurvivors and survivors, respectively. Colinearity between Delta Prs, a Crs and Pplat, rs, which was expected as these variables are a mathematically coupled, was statistically significant. Hazard ratios a from the Cox models for day-90 mortality were 1.05 (1.02-1.08) (P = a 0.005), 1.05 (1.01-1.08) (P = 0.008) and 0.985 (0.972-0.985) (P = 0.029) a for.Prs, Pplat, rs and Crs, respectively. PEEP and VT were not a associated with death in any model. a Conclusions: When ventilating patients with low VT,.Prs is a risk factor a for death in ARDS patients, as is Pplat, rs or Crs. As our data a originated from trials from which most ARDS patients were excluded due a to strict inclusion and exclusion criteria, these findings must be a validated in independent observational studies in patients ventilated a with a lung protective strategy.

Effect of driving pressure on mortality in ARDS patients during lung ă protective mechanical ventilation in two randomized controlled trials

Acute respiratory failure (ARF) in immunocompromised patients remains challenging to treat. A large number of case require admission to intensive care unit (ICU) where mortality remains high. Oxygenation without intubation is important in this setting. This review summarizes recent studies assessing oxygenation devices for immunocompromised patients. Previous studies showed that non-invasive ventilation (NIV) has been associated with lower intubation and mortality rates. Indeed, in recent years, the outcomes of immunocompromised patients admitted to the ICU have improved. In the most recent randomized controlled trials, including immunocompromised patients admitted to the ICU with ARF, neither NIV nor high-flow nasal oxygen (HFNO) could reduce the mortality rate. In this setting, other strategies need to be tested to decrease the mortality rate. Early admission strategy and avoiding late failure of oxygenation strategy have been assessed in retrospective studies. However, objective criteria are still lacking to clearly discriminate time to admission or time to intubation. Also, diagnosis strategy may have an impact on intubation or mortality rates. On the other hand, lack of diagnosis has been associated with a higher mortality rate. In conclusion, improving outcomes in immunocompromised patients with ARF may include strategies other than the oxygenation strategy alone. This review discusses other unresolved questions to decrease mortality after ICU admission in such patients.

Oxygenation strategy during acute respiratory failure in immunocompromised patients

Acute Respiratory Distress Syndrome following Hematopoietic Stem Cell Transplantation: One More Piece in the Puzzle

Exploring Associations Between Respiratory Mechanics and Survival in Immunocompromised Patients With ARDS.

Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS A Secondary Analysis of the EFRAIM Study

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Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS A Secondary Analysis of the EFRAIM Study