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Driving Pressure Reduction Strategy — FRCA Final MCQ

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HardIntensive Care MedicineDriving Pressure Reduction StrategyFRCA Final

A 50-year-old man on ICU with ARDS is being ventilated. His settings are: VT 400 mL (6 mL/kg IBW), RR 22, PEEP 12, FiO2 0.7, Pplat 28. His driving pressure is 16 cmH2O. How should the driving pressure be reduced?

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Correct answer: E — Both reduce VT and/or increase PEEP (to improve compliance) – titrate to ΔP <15

Driving pressure (ΔP) = Pplat – PEEP = 28 – 12 = 16 cmH2O. To reduce ΔP to <15: either reduce VT (directly reduces Pplat) OR increase PEEP (if this recruits more lung and improves compliance, Pplat may not rise proportionally to the PEEP increase, reducing ΔP). The optimal strategy depends on whether the lung is recruitable. If increasing PEEP from 12 to 14 improves compliance (recruits atelectatic lung), Pplat might only rise to 29, giving ΔP = 15. Alternatively, reducing VT to 350 mL would directly reduce ΔP.

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