Protective mechanical ventilation controlled by the real-time mechanical power measurement

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Mechanical Ventilation

Background:

• Despite advancements, mechanical ventilation (MV) is associated with high mortality.
• Mechanical power (MP), a measure of MV forces, correlates with patient outcomes.
• Real-time MP monitoring and adjustment may optimize MV settings.

Purpose of the Study:

• To assess the feasibility and impact of real-time mechanical power (MP) monitoring on mechanical ventilation (MV) settings.
• To compare MP levels between a group with real-time MP monitoring and a control group.
• To identify potential risks associated with MP variations during MV.

Main Methods:

• A randomized controlled trial was conducted involving adult patients with acute respiratory failure receiving MV.
• A novel system for real-time MP monitoring using geometric and simplified Becher's formulas was developed.
• The intervention group received MV with real-time MP visualization, while the control group had concealed MP values.

Main Results:

• No significant difference in MP was observed between the intervention and control groups.
• A weak but significant correlation was found between the two MP measurement methods (MP_Geom and MP_Becher).
• Significantly higher MP levels were recorded during nighttime compared to daytime hours.

Conclusions:

• Real-time MP measurement is technically feasible but did not significantly reduce MP in this trial.
• Experienced physicians can safely manage MV without explicit real-time MP data.
• Nighttime represents a high-risk period for potential lung injury due to elevated MP during MV.