Mean airway pressure has the potential to become the core pressure indicator of mechanical ventilation: Raising to the front from behind the clinical scenes

Mean airway pressure (Pmean) is a common pressure monitoring parameter of mechanical ventilators that is closely correlated with mean alveolar pressure and represents stresses applied to the lung parenchyma during ventilation. Pmean is determined by the peak inspiratory pressure, positive end-expiratory pressure (PEEP), and inspiratory-to-expiratory time ratio with dynamic and real-time characteristics, which represents mechanical power affected by the ventilator mode. Additionally, Pmean is an important parameter that affects hemodynamics. Tidal forces and PEEP increase pulmonary vascular resistance (PVR) in direct proportion to their effects on Pmean. Therefore, Pmean is increasingly considered to be related to the prognosis of patients on mechanical ventilation. We propose a 3P strategy (Pmean, central venous pressure [CVP], and perfusion index [PI]) which is indicated to achieve circulation protection mechanical ventilation with flow priority. Titrating the appropriate CVP and meeting PI to ensure tissue perfusion with a lower Pmean are the core purposes. Pmean links the circulatory and respiratory systems and is expected to become a potential parameter for intelligent ventilation.