Elevated Driving Pressure in Pressure-Controlled Ventilation: An Independent Risk Factor for Adverse Outcomes in Mechanically Ventilated Neonates.

The composite adverse outcome rate was significantly higher in the High DP group compared to the Low DP group.

• Composite adverse outcome rate was 44.7% in the High DP group versus 21.7% in the Low DP group (P = 0.03).
• The composite outcome included BPD, severe intraventricular hemorrhage (IVH grade ≥ III), need for surgical intervention, or death.
• The study included 145 neonates who received invasive conventional mechanical ventilation for ≥72 hours between January 1, 2020 and December 31, 2024.
• Patients were grouped into High DP (≥10 cmH2O) and Low DP (<10 cmH2O).

BPD incidence was significantly higher in the High DP group than the Low DP group.

• BPD incidence was 25.0% in the High DP group versus 8.7% in the Low DP group (P = 0.009).
• The increased BPD incidence was identified as the primary driver of the composite adverse outcome difference between groups.
• DP was calculated by subtracting applied PEEP from peak inspiratory pressure (PIP), following common clinical practice in pressure-controlled ventilation.

Multivariate analysis identified High DP and gestational age <32 weeks as independent risk factors for adverse outcomes.

• High DP was independently associated with adverse outcomes with an adjusted odds ratio of 5.30 (95% CI, 2.20–12.74).
• Gestational age <32 weeks was independently associated with adverse outcomes with an adjusted odds ratio of 11.11 (95% CI, 4.35–28.36).
• These findings were derived from multivariate logistic regression analysis in the full cohort of 145 neonates.

In the NRDS subgroup of preterm infants <32 weeks, both High DP and higher CRIB II score independently predicted BPD with comparable discriminatory ability.

• The NRDS subgroup included 61 preterm infants <32 weeks with neonatal respiratory distress syndrome.
• High DP independently predicted BPD with an adjusted odds ratio of 5.80 (95% CI, 1.61–20.90).
• Higher CRIB II score independently predicted BPD with an adjusted odds ratio of 4.44 (95% CI, 1.28–15.42).
• Discriminatory ability was comparable between the two predictors: DP AUC = 0.707 and CRIB II AUC = 0.733.

Lower DP was protective against progression to more severe BPD.

• Lower DP was associated with an adjusted odds ratio of 0.20 for progression to more severe BPD (P = 0.008).
• This finding suggests a dose-response relationship between DP levels and BPD severity.

The study recommends routine DP monitoring combined with clinical scoring to improve early risk stratification and facilitate individualized lung-protective ventilation.

• DP is described as an 'independent, modifiable risk factor' for adverse outcomes, distinguishing it from non-modifiable risk factors such as gestational age.
• The authors suggest combining DP monitoring with clinical scoring tools such as CRIB II for risk stratification.
• The effect of elevated DP was described as 'most pronounced in very preterm infants.'