Driving Down Mortality: A 12-Year Retrospective Cohort Anaysis of Mechanical Power and Driving Pressure in Ventilated ICU Patients

Background and Objectives: Mechanical ventilation, though life saving for patients with Acute Respiratory Distress Syndrome (ARDS), carries the risk of Ventilator-Induced Lung Injury (VILI) through mechanisms such as alveolar volutrauma and barotrauma. These injuries can exacerbate systemic inflammation and hinder recovery, particularly in compromised lungs. Lung and Diaphragm Protective Ventilation (LDPV) has demonstrated significant survival benefits, with driving pressure (ΔP) emerging as a key predictor of outcomes. This study evaluated whether a standardized Lung and Diaphragm Protective Ventilation (LDPV) protocol, optimizing ΔP and MP, reduced ICU mortality in mechanically ventilated patients over 12 years (2012–2024). Materials and Methods: This retrospective cohort study included all adult ICU patients requiring invasive mechanical ventilation between January 2012 and December 2024. A standardized LDPV protocol was introduced in November–December 2018 for all intubated patients, incorporating low Tidal Volumes (TV) (6–8 mL/kg), individualized Positive End Expiratory Pressure (PEEP), ΔP <15 cmH₂O, and reduced MP. Patients were categorized into pre-LDPV (2012–2018) and post-LDPV (2019–2024) groups. Primary outcome was ICU mortality. Secondary outcomes included temporal trends in ΔP, MP, and other ventilatory parameters (TV, PEEP, compliance, peak inspirator pressure). Results: Implementation of the LDPV strategy was associated with a significant reduction in ICU mortality, despite increasing number of admitted patienst, age and illness severity over time. Both ΔP and MP declined progressively in 2019-2024 group, particularly after protocol adoption. Improvements were also observed in compliance, tidal volumes, and SOFA scores in the 2019-2024 period. Conclusions: Systematic optimization of ΔP and MP through an LDPV protocol is associated with markedly improved survival in mechanically ventilated patients. These findings support the incorporation of real-time ΔP/MP monitoring into routine ICU practice to guide personalized, physiology-based ventilation strategies.