Driving pressure as a target for lung protective strategies: from ARDS critically-ill patients to the operating room—Lessons from the IMPROVE-2 Trial

Abstract

Protecting the lung from injurious strain imposed by mechanical ventilation remains a cornerstone in perioperative and critical care medicine. Yet, how best to achieve this goal and whether this strategy translates into improved outcomes in patients without established acute respiratory distress syndrome (ARDS) continues to spark debate. The recently published IMPROVE-2 trial by Futier et al. [1] adds an important piece to this discussion, examining whether targeting driving pressure (DP) to individualize positive end expiratory pressure (PEEP) in the operating room can prevent postoperative pulmonary complications in patients at risk of postoperative respiratory failure.