Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts - PubMed (original) (raw)
Observational Study
. 2018 Nov;44(11):1914-1922.
doi: 10.1007/s00134-018-5375-6. Epub 2018 Oct 5.
Ary Serpa Neto 1 2 3, Rodrigo Octavio Deliberato 4 5 6, Lieuwe D Bos 8, Pedro Amorim 9, Silvio Moreto Pereira 9, Denise Carnieli Cazati 4, Ricardo L Cordioli 4, Thiago Domingos Correa 4, Tom J Pollard 7, Guilherme P P Schettino 4, Karina T Timenetsky 4, Leo A Celi 7 10, Paolo Pelosi 11 12, Marcelo Gama de Abreu 13, Marcus J Schultz 8 14; PROVE Network Investigators
Affiliations
- PMID: 30291378
- DOI: 10.1007/s00134-018-5375-6
Observational Study
Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts
Ary Serpa Neto et al. Intensive Care Med. 2018 Nov.
Abstract
Purpose: Mechanical power (MP) may unify variables known to be related to development of ventilator-induced lung injury. The aim of this study is to examine the association between MP and mortality in critically ill patients receiving invasive ventilation for at least 48 h.
Methods: This is an analysis of data stored in the databases of the MIMIC-III and eICU. Critically ill patients receiving invasive ventilation for at least 48 h were included. The exposure of interest was MP. The primary outcome was in-hospital mortality.
Results: Data from 8207 patients were analyzed. Median MP during the second 24 h was 21.4 (16.2-28.1) J/min in MIMIC-III and 16.0 (11.7-22.1) J/min in eICU. MP was independently associated with in-hospital mortality [odds ratio per 5 J/min increase (OR) 1.06 (95% confidence interval (CI) 1.01-1.11); p = 0.021 in MIMIC-III, and 1.10 (1.02-1.18); p = 0.010 in eICU]. MP was also associated with ICU mortality, 30-day mortality, and with ventilator-free days, ICU and hospital length of stay. Even at low tidal volume, high MP was associated with in-hospital mortality [OR 1.70 (1.32-2.18); p < 0.001] and other secondary outcomes. Finally, there is a consistent increase in the risk of death with MP higher than 17.0 J/min.
Conclusion: High MP of ventilation is independently associated with higher in-hospital mortality and several other outcomes in ICU patients receiving invasive ventilation for at least 48 h.
Keywords: Critically ill; Intensive care unit; Mechanical power; Mechanical ventilation; Mortality; Ventilator-induced lung injury.
Comment in
- The calculation of mechanical power is not suitable for intra-patient monitoring under pressure-controlled ventilation.
Zhao Z, Frerichs I, He H, Long Y, Möller K, Serpa Neto A, Schultz MJ. Zhao Z, et al. Intensive Care Med. 2019 May;45(5):749-750. doi: 10.1007/s00134-019-05536-x. Epub 2019 Feb 6. Intensive Care Med. 2019. PMID: 30725138 No abstract available. - Mechanical Power or the not harming power.
Solà MB, Fernández RF. Solà MB, et al. Med Intensiva (Engl Ed). 2024 Mar;48(3):131-132. doi: 10.1016/j.medine.2024.01.001. Epub 2024 Feb 22. Med Intensiva (Engl Ed). 2024. PMID: 38395691 No abstract available.
References
- Circulation. 2000 Jun 13;101(23):E215-20 - PubMed
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