Correspondence  |   November 2019
Driving Pressure–guided Ventilation: Comment
Author Notes
  • Medical College of Wisconsin, Milwaukee, Wisconsin. mfierro@mcw.edu
  • (Accepted for publication July 24, 2019.)
    (Accepted for publication July 24, 2019.)×
Article Information
Correspondence
Correspondence   |   November 2019
Driving Pressure–guided Ventilation: Comment
Anesthesiology 11 2019, Vol.131, 1193. doi:10.1097/ALN.0000000000002954
Anesthesiology 11 2019, Vol.131, 1193. doi:10.1097/ALN.0000000000002954
I read with interest Park et al.’s article “Driving Pressure during Thoracic Surgery: A Randomized Clinical Trial” which appeared in March’s edition of Anesthesiology.1  In this double-blinded, prospective study, the intraoperative utilization of driving pressure guided ventilation, in which positive end-expiratory pressure (PEEP) was incrementally titrated to achieve the lowest plateau pressure minus PEEP value at 6 ml/kg tidal volume (VT), reduced the incidence of postoperative pneumonia and acute respiratory distress syndrome following thoracic surgery.1  Despite the success of this study, a potentially important concept which was not evaluated was the optimization of delivered tidal volume (VT) during the transition from two-lung to one-lung ventilation. Per the study protocol, subjects from both arms were ventilated with a fixed VT of 6 ml/kg, throughout all stages of the procedure. As the authors mention, a 6 ml/kg predicted body weight VT target is central to intensive care unit lung-protective ventilation, but the supporting data and practice itself may not be extrapolatable to one-lung ventilation. It is certainly possible that utilization of 6 ml/kg predicted body weight VT during one-lung ventilation could lead to more volutrauma and barotrauma than it would during two-lung ventilation.