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Mechanical power normalisation methods to predict ICU mortality: a retrospective cohort study.

Reza Khorasanee1, Barnaby Sanderson2, Emilia Tomarchio2

  • 1Department of Anaesthesia, Croydon University Hospital, London, CR7 7YE, UK. reza.khorasanee@nhs.net.

Annals of Intensive Care
|September 30, 2025
PubMed
Summary

Normalizing mechanical power (MP) to lung compliance or using the MP ratio improved predictions of ICU mortality in ventilated patients. These refined metrics offer better discrimination than unadjusted MP, though overall predictive power remains limited.

Keywords:
Acute respiratory distress syndromeErgotraumaMechanical powerMechanical ventilationNormalised mechanical powerVentilator-induced lung injuryVentilatory ratio

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Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Ventilator-induced lung injury (VILI) is a significant concern in mechanical ventilation.
  • Optimal strategies to minimize VILI are still under investigation.
  • Mechanical power (MP) is a recognized determinant of VILI, but its normalization requires further study.

Purpose of the Study:

  • To assess if normalizing MP to patient-specific factors improves its accuracy in predicting ICU mortality.
  • To explore the relationship between MP, MP ratio, and mortality, determining if it's linear or has a threshold effect.

Main Methods:

  • Retrospective analysis of electronic health records from 3,578 mechanically ventilated adults.
  • Evaluated MP normalized to dead space (ventilatory ratio, etc.), lung compliance, and a normal ideal MP (MP ratio).
  • Used logistic regression and Area Under the Receiver Operating Characteristic Curve (AUROC) to assess mortality prediction and linearity.

Main Results:

  • MP normalized to compliance (AUROC 0.71) and MP ratio (AUROC 0.71) showed improved discrimination for ICU mortality compared to unnormalized MP (AUROC 0.69).
  • Other normalization methods did not significantly enhance predictive accuracy.
  • A statistically significant, though small, non-linear relationship was observed between MP/MP ratio and ICU mortality.

Conclusions:

  • Mechanical power normalized to compliance and MP ratio offer superior discrimination for ICU mortality.
  • The improvement in predictive accuracy is modest, and the absolute predictive power remains limited.
  • Further research into VILI determinants and optimal ventilation strategies is warranted.