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Mechanical Power Is Associated With Mortality in Pressure-Controlled Ventilated Patients: A Dutch, Single-Center

Jamilla Goedegebuur¹, Floor E Smits², Jacob W M Snoep²

¹Department of Thrombosis and Hemostastis, Leiden University Medical Centre, Leiden, The Netherlands.

Critical Care Explorations

|December 19, 2024

Abstract

Importance:

Mechanical power (MP) could serve as a valuable parameter in clinical practice to estimate the likelihood of adverse outcomes. However, the safety thresholds for MP in mechanical ventilation remain underexplored and contentious.

Objectives:

This study aims to investigate the association between MP and hospital mortality across varying degrees of lung disease severity, classified by Pao2/Fio2 ratios.

Design, Setting, And Participants:

This is a retrospective cohort study using automatically extracted data. Patients admitted to the ICU of a tertiary referral hospital in The Netherlands between 2018 and 2024 and ventilated in pressure-controlled mode were included.

Main Outcomes And Measures:

Logistic regression, adjusted for age, sex, Acute Physiology and Chronic Health Evaluation-IV score, and Pao2/Fio2 ratio, was used to calculate the odds ratio (OR) for all-cause in-hospital mortality.

Results:

A total of 2184 patients were analyzed, with a mean age of 62.5 ± 13.8 years, of whom 1508 (70.2%) were male. The mean MP was highest in patients with the lowest Pao2/Fio2 ratios (21.5 ± 6.5 J/min) compared with those with the highest ratios (12.0 ± 3.8 J/min; p < 0.001). Adjusted analyses revealed that increased MP was associated with higher mortality (OR, 1.06; 95% CI, 1.03-1.09 per J/min increase). Similarly, MP normalized for body weight showed a stronger association with mortality (OR, 1.004; 95% CI, 1.002-1.006 per J/min/kg increase). An increase in mortality was seen when MP exceeded 16-18 J/min.

Conclusions And Relevance:

Our findings demonstrate a significant association between MP and hospital mortality, even after adjusting for key confounders. Mortality increases notably when MP exceeds 16-18 J/min. Normalized MP presents an even stronger association with mortality. These results underscore the need for further research into ventilation strategies that consider MP adjustments.

Insights

Mechanical power (MP) in mechanical ventilation is linked to higher hospital mortality, especially when exceeding 16-18 J/min. Normalized MP shows an even stronger association with adverse outcomes.

Area of Science:

Critical Care Medicine
Respiratory Physiology
Mechanical Ventilation

Background:

Mechanical power (MP) is a potential predictor of adverse outcomes in mechanical ventilation.
Safety thresholds for MP are not well-established.
Understanding MP's role across different lung disease severities is crucial.

Purpose of the Study:

To investigate the association between mechanical power (MP) and hospital mortality.
To analyze this association across varying degrees of lung disease severity (Pao2/Fio2 ratios).

Main Methods:

Retrospective cohort study utilizing automatically extracted ICU data.
Inclusion of patients ventilated in pressure-controlled mode.
Logistic regression adjusted for age, sex, APACHE-IV, and Pao2/Fio2 ratio to determine odds ratios for mortality.

Main Results:

2184 patients analyzed; mean age 62.5 years, 70.2% male.
Higher MP observed in patients with lower Pao2/Fio2 ratios (21.5 J/min vs. 12.0 J/min).
Increased MP associated with higher mortality (OR 1.06 per J/min increase); normalized MP stronger (OR 1.004 per J/min/kg). Mortality increased above 16-18 J/min.

Conclusions:

Significant association found between mechanical power and hospital mortality, independent of confounders.
Mechanical power exceeding 16-18 J/min is linked to increased mortality.
Normalized MP demonstrates a stronger association, suggesting its importance in ventilation strategies.

Read full analysis

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