[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-461538-105":59,"doc-detail-461538-en":129},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":122,"head_meta":124,"extra_data":126,"updated_unix":128},105,"en","mechanical-power-and-driving-pressure-mechanisms-of-lung-injury-markers-of-pathophysiology-or-therapeutic-targets","Mechanical Power and Driving Pressure - Mechanisms of Lung Injury, Markers of Pathophysiology, or Therapeutic Targets?","","Acute respiratory distress syndrome (ARDS) involves heterogeneous lung injury, where normal, unstable, and edematous tissue coexist and become vulnerable to secondary ventilator-induced lung injury (VILI). Although positive pressure ventilation initially reduced ARDS mortality, inappropriate settings can worsen outcomes. Lowering tidal volume and airway pressures reduced mortality, shifting attention toward driving pressure (ΔP) and, later, mechanical power delivered to the respiratory system (MPrs). Evidence also suggests normalization to compliance or end-expiratory lung volume better predicts outcomes, implying lung size and underlying pathophysiology govern VILI risk. Strategies should therefore prioritize restoring CRS and EELV rather than only adjusting ventilator settings.",{"@graph":69,"@context":121},[70,84,104],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/mechanical-power-and-driving-pressure-mechanisms-of-lung-injury-markers-of-pathophysiology-or-therapeutic-targets/461538/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":98,"encodingFormat":97,"isAccessibleForFree":99,"interactionStatistic":100},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/mechanical-power-and-driving-pressure-mechanisms-of-lung-injury-markers-of-pathophysiology-or-therapeutic-targets/461538.png","ImageObject",300,407,{"name":92,"@type":93},"awa","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-30",true,{"@type":101,"interactionType":102,"userInteractionCount":14},"InteractionCounter",{"@type":103},"ViewAction",{"@type":105,"mainEntity":106},"FAQPage",[107,113,117],{"name":108,"@type":109,"acceptedAnswer":110},"Why can mechanical ventilation worsen outcomes in ARDS?","Question",{"text":111,"@type":112},"Mechanical ventilation can become a double-edged sword: if ventilator settings are improperly chosen, they can increase secondary ventilator-induced lung injury (VILI) and worsen patient outcomes.","Answer",{"name":114,"@type":109,"acceptedAnswer":115},"How are driving pressure and mechanical power related to VILI risk?",{"text":116,"@type":112},"Driving pressure (ΔP) and mechanical power delivered to the respiratory system (MPrs) are recognized as biomarkers linked to VILI. However, newer evidence suggests that normalization of these measures to respiratory system compliance or end-expiratory lung volume is more informative.",{"name":118,"@type":109,"acceptedAnswer":119},"What is the proposed therapeutic focus beyond changing ventilator settings?",{"text":120,"@type":112},"Instead of only adjusting ventilator parameters to normalize ΔP or MPrs, the focus should shift toward gradually re-expanding collapsed lung tissue to restore normal CRS and EELV, which would reduce ΔP/MPrs at higher settings.","https://schema.org",{"og:url":83,"og:type":123,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":125,"canonical":83},"index,follow",{"doc_id":127,"site_id":62},461538,1790789605,{"code":4,"msg":5,"data":130},{"doc_id":127,"user_id":131,"nickname":92,"user_avatar":132,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":133,"file_id":134,"file_url":135,"file_type":136,"file_size":137,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":138,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},3985747858093,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Perspective  \nMechanical Power and Driving Pressure: Mechanisms of Lung Injury, Markers of Pathophysiology, or Therapeutic Targets?  \nGary Frank Nieman 1,2, *, Joaquin Araos 2, Joshua Satalin 2, Penny Andrews 3 and Nader Habashi 3  \nAcademic Editors: Adriano Peris and Epaminondas G. Zakynthinos  \nReceived: 10 November 2025  \nRevised: 15 December 2025  \nAccepted: 18 December 2025  \nPublished: 22 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department of Surgery, Upstate Medical University, Syracuse, NY 13210, USA  \n2 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA  \n3 Department of Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD 21201, USA  \n* [Correspondence: niemang@upstate.edu](Correspondence: niemang@upstate.edu); Tel.: +1-(315)-447-4619  \nAbstract  \nAcute respiratory distress syndrome (ARDS) causes heterogeneous injury, with normal, unstable, and edematous tissue distributed throughout the lung. Although positive pressure ventilation initially reduced ARDS-related mortality, it became clear that the ventilator can be a double-edged sword and, if set improperly, can worsen outcomes. This uneven pathology makes the lung vulnerable to secondary ventilator-induced lung injury (VILI) . In 2000, evidence showed that lowering tidal volume (VT ) and airway pressure significantly reduced mortality in patients with ARDS, suggesting that this reduction led to less overdistension of healthy lung tissue. Including respiratory system compliance (CRS ) in the calculation. It was shown that low driving pressure (∆P = VT/CRS) was more strongly associated with survival than low VT alone. This idea was further extended into measuring the mechanical power delivered to the respiratory system: MPrs = RR × ∆V2·[1/2·ELrs + RR·(1 + I:E)/60·I:E·Raw ] + ∆V·PEEP, where ELrs iselastance, I:E is inspiratory:expiratory ratio, Raw is airway resistance, and RR is respiratory rate. This measure helps identify when the lung is at risk of VILI. However, a recent study found no direct causal link between MP RS and mortality; rather, it showed that MPRS, normalized to CRS or end-expiratory lung volume (EELV), was independently associated with outcomes. This indicates that lung size and underlying pathophysiology—rather than ∆P or MP RS alone—are critical determinants of VILI risk. Reopening collapsed lung tissue would increase CRS and decrease ERS, thereby lowering ∆P or MPRS at any given VT, Raw, PEEP, I:E, or RR setting. Consequently, the focus should shift from simply adjusting the ventilator to normalize CRS and EELV that reduce ∆P or MPRS at higher ventilator settings.  \nKeywords: ARDS; VILI; mechanical power; driving pressure; lung recruitment; EELV  \nWhat does this work add that is new?  \n• This perspective study confirms that, for patients with ARDS, the current strategy to reduce the mechanical power of the respiratory system (MPrs ) to minimize ventilatorinduced lung injury (VILI) involves lowering ventilator settings, such as tidal volume, peak and end-expiratory pressures, or respiratory rate.  \n• New evidence indicates that, to measure VILI effectively, MPrs must be normalized to respiratory system compliance (CRS ) or end-expiratory lung volume (EELV), suggesting that lung pathophysiology and morphology are as crucial as elevated MPrs in causing VILI.  \n• Therefore, a better goal for reducing MPrs is to focus on gradually re-expand the ARDSlung, restoring normal CRS and EELV. This approach would lower MPrs at any given ventilator setting.  \n1. Introduction  \nThe acute respiratory distress syndrome (ARDS) remains a serious medical problem, with supportive care through mechanical ventilation as the primary treatment [1] . Incorrectly set mechanical ventilation is a known cau","cbCaihnQZ1Jzzalb","https://ap.wps.com/l/cbCaihnQZ1Jzzalb","pdf",5175257,18,"English","# Abstract\n# What does this work add that is new?\n# 1. Introduction","[{\"question\":\"Why can mechanical ventilation worsen outcomes in ARDS?\",\"answer\":\"Mechanical ventilation can become a double-edged sword: if ventilator settings are improperly chosen, they can increase secondary ventilator-induced lung injury (VILI) and worsen patient outcomes.\"},{\"question\":\"How are driving pressure and mechanical power related to VILI risk?\",\"answer\":\"Driving pressure (ΔP) and mechanical power delivered to the respiratory system (MPrs) are recognized as biomarkers linked to VILI. However, newer evidence suggests that normalization of these measures to respiratory system compliance or end-expiratory lung volume is more informative.\"},{\"question\":\"What is the proposed therapeutic focus beyond changing ventilator settings?\",\"answer\":\"Instead of only adjusting ventilator parameters to normalize ΔP or MPrs, the focus should shift toward gradually re-expanding collapsed lung tissue to restore normal CRS and EELV, which would reduce ΔP/MPrs at higher settings.\"}]","Mechanical Power and Driving Pressure - Mechanisms of Lung Injury, Markers of Pathophysiology, or Therapeutic Targets? | PDF",1790761830,45]