Which statement best describes driving pressure and risk of VILI?

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Driving pressure is the distending pressure the lungs experience with each breath, essentially the pressure that stretches the lungs during inspiration. It’s determined by how much tidal volume you deliver and how stiff or compliant the lung is, often described as plateau pressure minus PEEP (or tidal volume divided by respiratory system compliance). The risk of ventilator-induced lung injury rises with higher driving pressure because more stress and strain are placed on lung tissue, promoting overdistension and repetitive opening and closing of alveoli. Keeping driving pressure low reduces this stress, which is why lung-protective ventilation strategies—low tidal volumes with appropriate PEEP—tend to improve outcomes, especially in conditions like ARDS. Increasing driving pressure doesn’t guarantee better oxygen delivery and can worsen lung injury; oxygen delivery depends on multiple factors such as cardiac output, hemoglobin, and overall ventilation-perfusion balance, not just the distending pressure. So, the idea that lower driving pressure is associated with better outcomes best describes the relationship.