Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Jun 9, 2025; 14(2): 101377
Published online Jun 9, 2025. doi: 10.5492/wjccm.v14.i2.101377
Driving pressure in acute respiratory distress syndrome for developing a protective lung strategy: A systematic review
Hassan A Alzahrani, Nadia Corcione, Saeed M Alghamdi, Abdulghani O Alhindi, Ola A Albishi, Murad M Mawlawi, Wheb O Nofal, Samah M Ali, Saad A Albadrani, Meshari A AlJuaid, Abdullah M Alshehri, Mutlaq Z Alzluaq
Hassan A Alzahrani, Department of Respiratory Care, Medical Cities at the Minister of Interior, Riyadh 13321, Saudi Arabia
Nadia Corcione, Interventional Pulmonology, Antonio Cardarelli Hospital, Naples, Italy
Saeed M Alghamdi, Department of Clinical Technology, Respiratory Care Program, Umm-Al Qura University, Makkah al Mukarramah 21599, Saudi Arabia
Abdulghani O Alhindi, Respiratory Therapy Unit, Security Forced Hospital Program, Makkah al Mukarramah 26955, Saudi Arabia
Ola A Albishi, Department of Medical Affairs, Security Forced Hospital Program, Makkah al Mukarramah 25911, Saudi Arabia
Murad M Mawlawi, Department of Intensive Care Unit and Medical Affairs, Security Forced Hospital Program, Makkah al Mukarramah 23455, Saudi Arabia
Wheb O Nofal, Department of Pharmacy, Security Forced Hospital Program, Makkah al Mukarramah 23455, Saudi Arabia
Samah M Ali, Department of Internal Medicine, Security Forced Hospital Program, Makkah al Mukarramah 21955, Saudi Arabia
Saad A Albadrani, Meshari A AlJuaid, Department of Respiratory Therapy, King Faisal Medical Complex, Taif 29167, Saudi Arabia
Abdullah M Alshehri, Department of Respiratory Therapy, King Fahad, General Hospital, Taif 29167, Saudi Arabia
Mutlaq Z Alzluaq, Department of Respiratory Therapy, East Jeddah Hospital, First Jeddah Cluster, Jeddah 23235, Saudi Arabia
Author contributions: Alzahrani HA, Corcione N, Alghamdi SM, Alhindi AO, Albishi QA, Mawlawi MM, Nofal WO, Ali SM, Albadani SA, AlJuaid MA, Alshehri AM, and Alzluaq MZ were involved in the writing of the first draft, revision of manuscript, work design, data collection, data analysis and data interpretation; and all authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hassan A Alzahrani, Department of Respiratory Care, Medical Cities at the Minister of Interior, 6801 Al Imam Saud Ibn Faysal Road, Riyadh 13321, Saudi Arabia. halzahrani@moi.med.sa
Received: September 12, 2024
Revised: December 15, 2024
Accepted: January 3, 2025
Published online: June 9, 2025
Processing time: 168 Days and 0.1 Hours
Abstract
BACKGROUND

Acute respiratory distress syndrome (ARDS) is a critical condition characterized by acute hypoxemia, non-cardiogenic pulmonary edema, and decreased lung compliance. The Berlin definition, updated in 2012, classifies ARDS severity based on the partial pressure of arterial oxygen/fractional inspired oxygen fraction ratio. Despite various treatment strategies, ARDS remains a significant public health concern with high mortality rates.

AIM

To evaluate the implications of driving pressure (DP) in ARDS management and its potential as a protective lung strategy.

METHODS

We conducted a systematic review using databases including EbscoHost, MEDLINE, CINAHL, PubMed, and Google Scholar. The search was limited to articles published between January 2015 and September 2024. Twenty-three peer-reviewed articles were selected based on inclusion criteria focusing on adult ARDS patients undergoing mechanical ventilation and DP strategies. The literature review was conducted and reported according to PRISMA 2020 guidelines.

RESULTS

DP, the difference between plateau pressure and positive end-expiratory pressure, is crucial in ARDS management. Studies indicate that lower DP levels are significantly associated with improved survival rates in ARDS patients. DP is a better predictor of mortality than tidal volume or positive end-expiratory pressure alone. Adjusting DP by optimizing lung compliance and minimizing overdistension and collapse can reduce ventilator-induced lung injury.

CONCLUSION

DP is a valuable parameter in ARDS management, offering a more precise measure of lung stress and strain than traditional metrics. Implementing DP as a threshold for safety can enhance protective ventilation strategies, potentially reducing mortality in ARDS patients. Further research is needed to refine DP measurement techniques and validate its clinical application in diverse patient populations.

Keywords: Acute respiratory distress syndrome; Mechanical ventilation; Driving pressure; Respiratory care; Intensive care unit; Pulmonary disease

Core Tip: This manuscript reviews the concept of monitoring driving pressure generated by mechanical ventilation to protect the lung. The literature demonstrated that driving pressure (DP) is a valuable parameter in acute respiratory distress syndrome management, offering a more precise measure of lung stress and strain than traditional metrics. Implementing DP as a threshold for safety can enhance protective ventilation strategies, potentially reducing mortality in acute respiratory distress syndrome patients. Further research is needed to refine DP measurement techniques and validate its clinical application in diverse patient populations.