Abstract
Objective: This study aimed to assess the effect of mechanical ventilation based on predicted body weight (PBW) and driving pressure (DP) as directed in patients without acute respiratory distress syndrome (ARDS).
Design: Experimental, single-blind design with pretest-posttest control group design to assess the effect of using PBW and DP as a guide in regulating the amount of tidal volume and airway pressure in mechanically ventilated patients without ARDS.
Setting: We conducted this study in the Intensive Care Unit (ICU) at Dr. Wahidin Sudirohusodo General Hospital, Makassar, from November 2023 to March 2024.
Patients and participants: Patients with respiratory failure who were admitted to the ICU of Dr. Wahidin Sudirohusodo General Hospital, Makassar.
Intervention: Patients in the PBW group were given a tidal volume setting of 8 ml/kg PBW, adjusted to the lowest positive end-expiratory pressure (PEEP) with the largest lung compliance target, while the DP group did the same thing and adjusted the tidal volume regarding the driving pressure target. The oxygen partial pressure (pO2), carbon dioxide partial pressure (pCO2), oxygen partial pressure to fractional inspired oxygen ratio (P/F ratio), mechanical power, and ventilatory ratio were assessed at the first hour and 24th hour.
Measurement and results: Thirty-two patients were divided into two groups, 16 patients each, recruited from November 2023 to March 2024. There was a significant difference in the P/F ratio in the DP group compared to the PBW group after 24 hours (p<0.001 vs p=0.190). Similarly, pCO2 after 24 hours significantly differed between the DP group (p=0.001) and the PBW group (p=0.658). Regarding mechanical power, the two groups had no significant difference (10.92±2.51 vs 11.68±1.21 Joules/min, p=0.284). The PBW group had a wider range of mechanical power values (range 8.4 J/min) than the DP group (range 4.6 J/min), suggesting the DP group had more consistent mechanical power magnitude.
Conclusion: Mechanical ventilation guided by DP can improve oxygenation and ventilation outcomes. Even though both the PBW and DP methods resulted in similar mechanical power levels, the DP-guided approach provided more stable and predictable mechanical power values. This stability can benefit patient management in the ICU, as it suggests a reduced risk of lung injury and potentially better overall outcomes for patients receiving mechanical ventilation.
Syahyad Aryamehr, Syafri Kamsul Arif, Faisal Muchtar, Syamsul Hilal Salam, Haizah Nurdin
