• Elias N Baedorf Kassis, Stephanie Hu, MingYu Lu, JohnsonAlistair E WAEWLaboratory for Computational Physiology, Massachusetts Institute of Technology, Boston, Massachusetts., Somnath Bose, Maximilian S Schaefer, Daniel S Talmor, Li-Wei H Lehman, and Zach S Shahn.
• Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. enbaedor@bidmc.harvard.edu.
• Respir Care. 2023 Jan 30; 68 (2): 199207199-207.

BackgroundDriving pressure (ΔP) and mechanical power (MP) may be important mediators of lung injury in ARDS; however, there is little evidence for strategies directed at reducing these parameters. We applied predictive modeling to estimate the effects of modifying ventilator parameters on ΔP and MP.MethodsTwo thousand six hundred twenty-two subjects with ARDS (Berlin criteria) from the Medical Information Mart for Intensive Care IV version 1.0 database admitted to the ICU at Beth Israel Deaconess Medical Center between 2008-2019 were included. Flexible confounding-adjusted regression models for time-varying data were fit to estimate the effects of adjusting PEEP and tidal volume (VT) on ΔP and adjusting VT and breathing frequency on MP.ResultsReduction in VT reduced ΔP and MP, with more pronounced effect on MP with lower compliance. Strategies reducing frequency consistently increased MP (when VT was adjusted to maintain consistent minute ventilation). Adjustment of PEEP yielded a U-shaped effect on ΔP.ConclusionsThis novel conditional modeling confirmed expected response patterns for ΔP, with the response to adjustments depending on subjects' lung mechanics. Furthermore, a VT-driven approach should be favored over a breathing frequency-driven approach when aiming to reduce MP.Copyright © 2023 by Daedalus Enterprises.

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