Related Experiment Video
Updated: Aug 29, 2026

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
The Association Between Mechanical Power Within the First 24 Hours and ICU Mortality in Mechanically Ventilated Adult
Stephan von Düring1, Kuan Liu2, Laveena Munshi3
1Division of Intensive Care Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Geneva, Switzerland; Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Background:
Despite the widespread adoption of lung-protective ventilation strategies, mortality among patients receiving invasive mechanical ventilation (IMV) remains high. Mechanical power (MP) integrates various variables responsible for ventilator-induced lung injury and has been associated with mortality in patients with ARDS. However, the impact of MP on ICU mortality in the larger group of patients with acute hypoxemic respiratory failure (AHRF) has not been well established, and previous studies have reported inconsistent thresholds for predicting outcomes.
Research Question:
Is high MP (> 17 J/min) within the first 24 hours of IMV, calculated using dynamic driving pressure, associated with ICU mortality in patients with AHRF? Additionally, does a threshold exist below which IMV is considered safe?
Study Design And Methods:
In this multicenter cohort study, we included adult patients with AHRF who received IMV. Patients were excluded if they received IMV for > 24 hours before inclusion or were receiving extracorporeal life support. We applied multivariable logistic regression models with inverse probability of treatment weighting and used change-point regression models with restricted cubic splines.
Results:
Of the 21,714 patients in our registry, 9,031 patients (42%) met the inclusion criteria. After adjusting for baseline characteristics, high MP was associated with increased ICU mortality (OR, 1.58; 95% CI, 1.44-1.72), with a nonlinear dose-response relationship. No consistent safe MP threshold was identified. High MP also was associated with lower extubation rates and fewer ventilator-free days.
Interpretation:
In this study, exposure to high MP within the first 24 hours of IMV was associated with increased ICU mortality in patients with AHRF. The absence of a consistent safe threshold suggests that reducing MP at IMV initiation may be a strategy to improve outcomes, warranting exploration in clinical trials.
Related Concept Videos
Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
Acute Respiratory Failure-III
Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Mechanical Ventilation I: Indication and Settings
Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...

