Education  |   July 2019
Driving Pressure and Transpulmonary Pressure: How Do We Guide Safe Mechanical Ventilation?
Author Notes
  • From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts. Current Affiliation: Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland (E.C.W.).
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Submitted for publication September 5, 2018. Accepted for publication March 12, 2019.
    Submitted for publication September 5, 2018. Accepted for publication March 12, 2019.×
  • Address correspondence to Dr. Vidal Melo: 55 Fruit St, Gray Bigelow 444, Boston, Massachusetts 02114. VidalMelo.Marcos@mgh.harvard.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Respiratory System / Clinical Focus Review
Education   |   July 2019
Driving Pressure and Transpulmonary Pressure: How Do We Guide Safe Mechanical Ventilation?
Anesthesiology 7 2019, Vol.131, 155-163. doi:https://doi.org/10.1097/ALN.0000000000002731
Anesthesiology 7 2019, Vol.131, 155-163. doi:https://doi.org/10.1097/ALN.0000000000002731
Concern over the potential for lung injury due to mechanical ventilation has fueled investigations on lung protection in the operating room.1–3  Based on the intensive care literature,4  tidal volume (VT) and positive end-expiratory pressure (PEEP) settings have been the focus of intraoperative clinical trials.1–3  Recent results in acute respiratory distress syndrome (ARDS)5  and surgical patients6,7  have suggested that the benefits associated with VT and PEEP settings are mediated by driving pressures. As our understanding of the physical and biologic effects of mechanical ventilation evolves, the concepts of driving pressure and transpulmonary pressure have been increasingly used to quantify the mechanical forces acting over the lungs during mechanical ventilation and to guide clinical care. In this perspective, we discuss the definition of those concepts, their measurement in the clinical setting, their interpretation, and their use in typical scenarios.