Respiratory Therapy - Delta P vs Driving Pressure

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ARDS - Double-lumen Independent Lung Ventilation. We need to quit treating both lungs as one with ARDS! Volume or Pressure will always flow and expand to the least resistant lung. Driving pressure should be measured independently and symmetrically to prevent a reluctant and unnecessary pneumothorax! Great topic Respiratory Coach!

BarryDenton
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Our program (community college) is teaching this; first year students, second semester: Mechanical Ventilation & Critical Care. So glad!

emires
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We started using this with the Delta wave. Hard to use the P/V tool when your pressure is soft and pressors aren't helping. We had a trauma patient that needed a PEEP of 20. They were hesitant bc of plats in the high 30's but DP was 14. Sunk an esophageal balloon and confirmed with were spot on. Sometimes you have to prove yourself.

kristydobinski
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Hey Coach, it was nice meeting you at the AARC Congress. In the video you said you have to be in vol ctrl to assess the plateau pressure. The servo u and mindray ventilators have an inspiratory hold button that will allow you to check the plateau pressure in vol ctrl and pressure ctrl. Should I not use this inspiratory hold feature in pressure ctrl?

nigel
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Hey Coach! Been an RRT for 17 yrs, always looking to refresh memory and learn stuff! Our hospital intensivists are really pushing the “driving pressure” theory. My question is, can you calculate “DP” when a pt is in PS (pressure support) mode? So I had my pt in a PS of 5 cwp (VT in the 500 ml range) and PEEP of 20 cwp. The intensivist asked what the pt’s DP was. I told her it was 5-6 cwp. I subtracted my PEEP from my PIP. That’s not exactly the formula for DP, but you also said in another video that Pplat is always less than PIP Pt’s PaO2 was the best it had been in days. Unfortunately, the intensivist was concerned with my high PEEP, so she switched him to PC. PaO2 on her setting was less than what I had in PS!

patrickclausen
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hi is it possible to discuss inverse ratio and why we would use it please

sheiladupuy
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Keep going I love the way you explain thinks.


Amazing ❤️

kmssd
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Awesome explanation. Definitely will use this

elgerm
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We have a Draeger Perseus A500 ventilator that allows control of delta P, Pinsp, and PEEP. However, when Pinsp and PEEP are changed while on PCV the Delta P doesn't automatically change. Very confusing if Pinsp is also referring to PIP...

naterdawg
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your vids are amazing and a great help. Can you do a video on high flow vs low flow respiratory devices? Which one we choose based on patient assessment? etc

johndoe-yuze
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Great explanation. If the driving pressure is bigger then 15cmH20, does it r/t to ARDS (clarify) only, how about delta P, what is the normal range? High or low would make the lungs over pressure, what are type of patients in this population (delta p)?

KikiToth-xllu
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I unserstanded as driving pressure affecting lung physiology by openening alveoli membrane with peep. I think it's called driving pressure because of the pressure gradient created by peep to ventilate actual membrane. Delta pressure is just a name for a reflection on ventilation pressure behavior on any lung disease. I guess, drivingvpressure is becoming more popular because wevare actually ventilating membrane not just airway, which is the bottom line!

greensahuaro
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Is just a number to identify a pressure difference. That's all!

greensahuaro
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ECMO VV INDICATED FOR LUNG REST IN ARDS PATIENT.
WE KEEP THE PATIENT ON REST VENT SETTINGS AND ON SEDATION.
WHEN AWAKE BECOME AIR HUNGRY AND DISYNCHRONY
HOW TO MANAGE BY MV.

sumanmamun
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I understand how to calculate the driving pressure and how to use it in my assessment. However, I still don't understand how to define it. Is it possible for you to give a definition for it. For example, could you define it the way you would plateau pressure.

nigel
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Can I decrease driving pressure by increasing peep ?

takhtimgames
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Can we assess Plateau pressure in pressure controle with inspiratory hold ?

eman
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Driving P makes sense because it's telling the actual FRC space being ventilated!

greensahuaro
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I had physicans call driving pressure the inspiratory pressure set on pressure control, is that correct?

StephenHo-ld
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You want to see a pediatric doctor’s brain explode? Explain this to them when you put a baby on a vent🤯😆

veerchasm