84. RFJC 14 – ARDS Series – Driving Pressure

Driving pressure—defined as the difference between plateau pressure and PEEP—serves as a superior metric for predicting mortality in ARDS patients compared to individual ventilator settings like tidal volume or PEEP. A retrospective analysis of over 3,500 patients across nine clinical trials demonstrates that survival benefits associated with lung-protective ventilation are primarily mediated by reductions in driving pressure. While higher plateau pressures and PEEP levels are often scrutinized, they do not consistently correlate with mortality outcomes unless driving pressure is also affected. Despite its clinical utility, this metric remains limited by its retrospective derivation, the lack of prospective randomized trials, and its unreliability in patients with spontaneous respiratory effort or low chest wall compliance, such as those with obesity. Consequently, clinicians should prioritize minimizing driving pressure as a key component of lung-protective strategies while awaiting further prospective validation.