Mechanical Power Is Associated With Mortality in Pressure-Controlled Ventilated Patients: A Dutch, Single-Center Cohort Study.

Q4 Medicine

Critical care explorations Pub Date : 2024-12-19 eCollection Date: 2024-12-01 DOI:10.1097/CCE.0000000000001190

Jamilla Goedegebuur, Floor E Smits, Jacob W M Snoep, Petra J Rietveld, Franciska van der Velde, Evert de Jonge, Abraham Schoe

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Abstract

Importance: Mechanical power (MP) could serve as a valuable parameter in clinical practice to estimate the likelihood of adverse outcomes. However, the safety thresholds for MP in mechanical ventilation remain underexplored and contentious.

Objectives: This study aims to investigate the association between MP and hospital mortality across varying degrees of lung disease severity, classified by Pao2/Fio2 ratios.

Design, setting, and participants: This is a retrospective cohort study using automatically extracted data. Patients admitted to the ICU of a tertiary referral hospital in The Netherlands between 2018 and 2024 and ventilated in pressure-controlled mode were included.

Main outcomes and measures: Logistic regression, adjusted for age, sex, Acute Physiology and Chronic Health Evaluation-IV score, and Pao2/Fio2 ratio, was used to calculate the odds ratio (OR) for all-cause in-hospital mortality.

Results: A total of 2184 patients were analyzed, with a mean age of 62.5 ± 13.8 years, of whom 1508 (70.2%) were male. The mean MP was highest in patients with the lowest Pao2/Fio2 ratios (21.5 ± 6.5 J/min) compared with those with the highest ratios (12.0 ± 3.8 J/min; p < 0.001). Adjusted analyses revealed that increased MP was associated with higher mortality (OR, 1.06; 95% CI, 1.03-1.09 per J/min increase). Similarly, MP normalized for body weight showed a stronger association with mortality (OR, 1.004; 95% CI, 1.002-1.006 per J/min/kg increase). An increase in mortality was seen when MP exceeded 16-18 J/min.

Conclusions and relevance: Our findings demonstrate a significant association between MP and hospital mortality, even after adjusting for key confounders. Mortality increases notably when MP exceeds 16-18 J/min. Normalized MP presents an even stronger association with mortality. These results underscore the need for further research into ventilation strategies that consider MP adjustments.

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机械动力与压力控制通气患者死亡率相关：一项荷兰单中心队列研究。

重要性：机械功率（MP）可作为临床实践中评估不良后果可能性的有价值参数。然而，机械通气中MP的安全阈值仍未得到充分探讨和争议。目的：本研究旨在探讨不同肺部疾病严重程度（Pao2/Fio2比值）中MP与医院死亡率之间的关系。设计、设置和参与者：这是一项使用自动提取数据的回顾性队列研究。纳入了2018年至2024年在荷兰一家三级转诊医院ICU住院并以压力控制模式通气的患者。主要结局和测量方法：采用Logistic回归，调整年龄、性别、急性生理和慢性健康评估- iv评分和Pao2/Fio2比值，计算全因住院死亡率的优势比（OR）。结果：共分析2184例患者，平均年龄62.5±13.8岁，其中男性1508例（70.2%）。Pao2/Fio2比值最低的患者平均MP最高（21.5±6.5 J/min），高于Pao2/Fio2比值最高的患者（12.0±3.8 J/min）；P < 0.001)。调整后的分析显示，MP升高与较高的死亡率相关(OR, 1.06；95% CI, 1.03-1.09 / J/min)。同样，体重标准化后的MP与死亡率的相关性更强(OR, 1.004；95% CI为1.002-1.006 / J/min/kg)。当MP超过16-18 J/min时，死亡率增加。结论和相关性：我们的研究结果表明，即使在调整了关键混杂因素后，MP和医院死亡率之间也存在显著关联。当MP超过16-18 J/min时，死亡率显著增加。规范化的MP与死亡率的关联更强。这些结果强调需要进一步研究考虑MP调整的通风策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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