Jamilla Goedegebuur, Floor E Smits, Jacob W M Snoep, Petra J Rietveld, Franciska van der Velde, Evert de Jonge, Abraham Schoe
{"title":"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。","authors":"Jamilla Goedegebuur, Floor E Smits, Jacob W M Snoep, Petra J Rietveld, Franciska van der Velde, Evert de Jonge, Abraham Schoe","doi":"10.1097/CCE.0000000000001190","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>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.</p><p><strong>Objectives: </strong>This study aims to investigate the association between MP and hospital mortality across varying degrees of lung disease severity, classified by Pao2/Fio2 ratios.</p><p><strong>Design, setting, and participants: </strong>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.</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions and relevance: </strong>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.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":"6 12","pages":"e1190"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661764/pdf/","citationCount":"0","resultStr":"{\"title\":\"Mechanical Power Is Associated With Mortality in Pressure-Controlled Ventilated Patients: A Dutch, Single-Center Cohort Study.\",\"authors\":\"Jamilla Goedegebuur, Floor E Smits, Jacob W M Snoep, Petra J Rietveld, Franciska van der Velde, Evert de Jonge, Abraham Schoe\",\"doi\":\"10.1097/CCE.0000000000001190\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Importance: </strong>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.</p><p><strong>Objectives: </strong>This study aims to investigate the association between MP and hospital mortality across varying degrees of lung disease severity, classified by Pao2/Fio2 ratios.</p><p><strong>Design, setting, and participants: </strong>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.</p><p><strong>Main outcomes and measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions and relevance: </strong>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.</p>\",\"PeriodicalId\":93957,\"journal\":{\"name\":\"Critical care explorations\",\"volume\":\"6 12\",\"pages\":\"e1190\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-12-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661764/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical care explorations\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/CCE.0000000000001190\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical care explorations","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/CCE.0000000000001190","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
Mechanical Power Is Associated With Mortality in Pressure-Controlled Ventilated Patients: A Dutch, Single-Center Cohort Study.
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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