title: Altering the mechanical scenario to decrease the driving pressure.
abstract: Ventilator settings resulting in decreased driving pressure (ΔP) are positively associated with survival. How to further foster the potential beneficial mediator effect of a reduced ΔP? One possibility is promoting the active modification of the lung's "mechanical scenario" by means of lung recruitment and positive end-expiratory pressure selection. By taking into account the individual distribution of the threshold-opening airway pressures to achieve maximal recruitment, a redistribution of the tidal volume from overdistended to newly recruited lung occurs. The resulting more homogeneous distribution of transpulmonary pressures may induce a relief of overdistension in the upper regions. The gain in lung compliance after a successful recruitment rescales the size of the functional lung, potentially allowing for a further reduction in ΔP.
authors.affiliation: Hedenstierna Laboratory, Department of Surgical Sciences, Section of Anaesthesiology & Critical Care, Uppsala University, Hospital, 75185, Uppsala, Sweden. joao.batista_borges@surgsci.uu.se.
authors.forename: João Batista
authors.initials: JB
authors.lastname: Borges
authors.affiliation: Hedenstierna Laboratory, Department of Medical Sciences, Clinical Physiology, Uppsala University, Hospital, 75185, Uppsala, Sweden. goran.hedenstierna@medsci.uu.se.
authors.forename: Göran
authors.initials: G
authors.lastname: Hedenstierna
authors.affiliation: Hedenstierna Laboratory, Department of Surgical Sciences, Section of Anaesthesiology & Critical Care, Uppsala University, Hospital, 75185, Uppsala, Sweden. anders.larsson@surgsci.uu.se.
authors.forename: Anders
authors.initials: A
authors.lastname: Larsson
authors.affiliation: Hedenstierna Laboratory, Department of Surgical Sciences, Section of Anaesthesiology & Critical Care, Uppsala University, Hospital, 75185, Uppsala, Sweden. fsuarez.sipmann@surgsci.uu.se.
authors.forename: Fernando
authors.initials: F
authors.lastname: Suarez-Sipmann
mesh_terms: D006801:Humans; D008168:Lung / Q000503:physiopathology*; D011175:Positive-Pressure Respiration / Q000379:methods* / Q000401:mortality; D011312:Pressure / Q000009:adverse effects*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology*; D012122:Ventilators, Mechanical