Drive to Survive: Dynamic Driving Pressure and Survival in the Trauma Population

Abstract

Background

Driving pressure (ΔP), the difference between peak inspiratory pressure (PIP) or plateau pressure (Pplat) and positive end-expiratory pressure (PEEP), has been proposed as a better target for avoiding ventilator-induced lung injury (VILI) in mechanically ventilated patients. This study aimed to determine if lower dynamic ΔP would correlate with reduced mortality and lower incidences of VILI.

Methods

A single-center retrospective analysis identified 237 trauma patients admitted in 2020 who underwent ≥48 hours of mechanical ventilation and survived ≥72 hours. The primary outcomes were 30-day hospital mortality and development of acute hypoxic VILI. Univariate and multivariate analyses assessed variables associated with 30-day mortality and VILI incidence.

Results

The cohort had a median age of 45 years, predominantly male (83.1%), with most admitted for blunt trauma (62.4%). The median ventilation duration was 6 days. Mortality was 20% for patients with ΔP ≤ 15 cm H₂O and 32% for those with higher ΔP (P = 0.04). Ventilator-induced lung injury incidence was higher in patients with ΔP ≥ 15 cm H₂O (34% vs 19%; P = 0.01). Multivariate analysis, adjusting for age, Injury Severity Score (ISS), and presence of intracranial bleed, indicated that an average ΔP ≥ 15 cm H₂O was associated with an increased risk of 30-day mortality (OR 2.4; 95% CI 1.2-4.8, P = 0.02) and higher VILI incidence (OR 2.2; 95% CI 1.2-4.0, P = 0.01).

Conclusions

Among trauma patients requiring at least 48 hours of mechanical ventilation, employing strategies to limit dynamic ΔP to less than 15 cm H₂O may reduce 30-day mortality and the incidence of acute VILI.