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The Association between Mechanical Power and Mortality in Patients with Pneumonia Using Pressure-Targeted Ventilation

Huang-Pin Wu^1,2, Chien-Ming Chu^1,2, Li-Pang Chuang^2,3

¹Division of Pulmonary, Critical Care and Sleep Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan.

Diagnostics (Basel, Switzerland)

|October 23, 2021

Abstract:

Recent studies have reported that mechanical power (MP) is associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). We aimed to investigate the association between 28-day mortality and MP in patients with severe pneumonia. In total, the data of 313 patients with severe pneumonia were used for analysis. Serial MP was calculated daily for either 21 days or until ventilator support was no longer required. Compared with the non-ARDS group, the ARDS group (106 patients) demonstrated lower age, a higher Acute Physiology and Chronic Health Evaluation II score, lower history of diabetes mellitus, elevated incidences of shock and jaundice, higher MP and driving pressure on Day 1, and more deaths within 28 days. Regression analysis revealed that MP was an independent factor associated with 28-day mortality (odds ratio, 1.048; 95% confidence interval, 1.020-1.077). MP was persistently high in non-survivors and low in survivors among the ARDS group, the non-ARDS group, and all patients. These findings indicate that MP is associated with the 28-day mortality in ventilated patients with severe pneumonia, both in the ARDS and non-ARDS groups. MP had a better predicted value for the 28-day mortality than the driving pressure.

Insights

Mechanical power (MP) is linked to 28-day mortality in severe pneumonia patients. High MP predicts worse outcomes, regardless of acute respiratory distress syndrome (ARDS) status, offering a better prognostic value than driving pressure.

Area of Science:

Critical Care Medicine
Respiratory Medicine
Pulmonary Physiology

Background:

Mechanical power (MP) is increasingly recognized as a mortality predictor in acute respiratory distress syndrome (ARDS).
Severe pneumonia presents a significant risk for mortality, especially in mechanically ventilated patients.
The prognostic role of MP in severe pneumonia, including ARDS and non-ARDS subgroups, requires further elucidation.

Purpose of the Study:

To investigate the association between daily serial mechanical power (MP) and 28-day mortality in patients with severe pneumonia.
To compare the predictive value of MP against driving pressure for 28-day mortality.
To analyze MP trends in survivors versus non-survivors.

Main Methods:

Analysis of data from 313 patients with severe pneumonia.
Daily calculation of serial MP for up to 21 days or until ventilator weaning.
Comparison of clinical characteristics and outcomes between ARDS and non-ARDS groups.

Main Results:

The ARDS group exhibited higher MP and driving pressure on Day 1 compared to the non-ARDS group.
Mechanical power (MP) was identified as an independent factor associated with 28-day mortality (OR, 1.048; 95% CI, 1.020-1.077).
Persistently high MP levels were observed in non-survivors, while survivors consistently showed lower MP levels.

Conclusions:

Mechanical power (MP) is significantly associated with 28-day mortality in mechanically ventilated patients with severe pneumonia, irrespective of ARDS development.
MP demonstrates a superior predictive capability for 28-day mortality compared to driving pressure.
MP monitoring may aid in risk stratification and management of severe pneumonia patients.

Read full analysis

Keywords:

acute respiratory distress syndrome driving pressure mechanical power non-acute respiratory distress syndrome pneumonia

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