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Mechanical Power and its Components vs Driving Pressure for Predicting Mortality in Acute Respiratory Distress

Pratik P Medhi1, Souvik Chaudhuri1, Vishwas Parampalli1

  • 1Department of Critical Care Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine
|November 10, 2025
PubMed
Abstract

Insights

Mechanical power is higher in acute respiratory distress syndrome (ARDS) non-survivors but not an independent mortality predictor. Driving pressure, however, independently predicts ARDS mortality, with dynamic elastic power contributing most to high mechanical power.

Area of Science:

  • Critical Care Medicine
  • Respiratory Medicine
  • Clinical Physiology

Background:

  • Mechanical power (MP) is a proposed predictor of mortality in acute respiratory distress syndrome (ARDS).
  • Existing evidence on the prognostic utility of MP in ARDS is conflicting.
  • This study investigates the predictive value of MP for ARDS mortality.

Purpose of the Study:

  • To evaluate the prognostic utility of mechanical power (MP) in predicting mortality among patients with acute respiratory distress syndrome (ARDS).
  • To compare the predictive value of MP and its components against driving pressure (DP) for ARDS mortality.

Main Methods:

  • A single-center prospective observational study included 137 ARDS patients.
  • Data collected included organ dysfunction scores, MP and its components, driving pressure, AKI severity, lung ultrasound scores, pulmonary artery hypertension, ICU stay, and mortality.
  • Statistical analyses included Mann-Whitney U-test and Cox-proportional hazard models.

Main Results:

  • Mechanical power was significantly higher in non-survivors (29 J/min) compared to survivors (24 J/min) (p < 0.001).
  • However, MP was not an independent predictor of mortality after adjusting for confounders.
  • Driving pressure >16 cm H2O was an independent predictor of mortality (HR 2.925, p < 0.001).
  • The dynamic elastic power component was the main contributor to high MP.

Conclusions:

  • While mechanical power is higher in ARDS non-survivors, it is not an independent predictor of mortality.
  • Driving pressure is identified as an independent predictor of mortality in ARDS patients.
  • Dynamic elastic power is the most significant component contributing to elevated mechanical power.
Keywords:
Acute respiratory distress syndromeDriving pressureElastic dynamic powerMechanical powerMortality

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