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Driving Pressure Calculation — FRCA Final MCQ

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ModerateIntensive Care MedicineDriving Pressure CalculationFRCA Final

An ICU patient is receiving mechanical ventilation with the following settings: VT 450 mL, PEEP 10 cmH2O, Pplat 28 cmH2O. What is the driving pressure, and is it within the recommended range?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — 18 cmH2O – within recommended range

Driving pressure (ΔP) = Plateau pressure – PEEP = 28 – 10 = 18 cmH2O. The recommended driving pressure target in ARDS is <15 cmH2O (Amato et al, 2015 individual patient data meta-analysis), as it is the strongest ventilatory parameter predictor of mortality. A driving pressure of 18 cmH2O is above the recommended threshold and suggests either the tidal volume is too high for the available lung volume or PEEP is suboptimal. Options include reducing tidal volume further or optimising PEEP to improve compliance.

Reference: Amato MBP et al – 2015 – Driving pressure and survival in ARDS; ICS – 2024 – ARDS ventilation guidelines