Correspondence  |   November 2019
Driving Pressure–guided Ventilation: Reply
Author Notes
  • Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, Korea (H.J.A.). hyunjooahn@skku.edu
  • (Accepted for publication July 24, 2019.)
    (Accepted for publication July 24, 2019.)×
Article Information
Correspondence
Correspondence   |   November 2019
Driving Pressure–guided Ventilation: Reply
Anesthesiology 11 2019, Vol.131, 1194-1195. doi:10.1097/ALN.0000000000002952
Anesthesiology 11 2019, Vol.131, 1194-1195. doi:10.1097/ALN.0000000000002952
We thank Dr. Fierro for his emphasis on tidal volume reduction in response to our recent article “Driving Pressure during Thoracic Surgery: A Randomized Clinical Trial.”1  The definition of driving pressure is: plateau pressure − positive end expiratory pressure. Another formula of driving pressure is: tidal volume / static lung compliance. Therefore, reduction of tidal volume can also reduce driving pressure. However, the key point is that reduction of tidal volume can increase driving pressure if it deceases lung compliance (as in atelectasis), or increased tidal volume can decrease driving pressure if it increases lung compliance (as in recruitment). Therefore, reduction of tidal volume would decrease driving pressure until it reaches to the point where lung compliance starts to decrease. No study ever tested tidal volume in terms of driving pressure and it would be another interesting study subject. We think optimal tidal volume would be different in each individual if it is based on the lowest driving pressure.