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Intensive Care Medicine

, Volume 44, Issue 11, pp 1914–1922 | Cite as

Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts

  • Ary Serpa Neto
  • Rodrigo Octavio Deliberato
  • Alistair E. W. Johnson
  • Lieuwe D. Bos
  • Pedro Amorim
  • Silvio Moreto Pereira
  • Denise Carnieli Cazati
  • Ricardo L. Cordioli
  • Thiago Domingos Correa
  • Tom J. Pollard
  • Guilherme P. P. Schettino
  • Karina T. Timenetsky
  • Leo A. Celi
  • Paolo Pelosi
  • Marcelo Gama de Abreu
  • Marcus J. Schultz
  • for the PROVE Network Investigators
Original

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

Mechanical ventilation Mechanical power Mortality Critically ill Intensive care unit Ventilator-induced lung injury 

Notes

Acknowledgments

To the team of the Laboratory for Computational Physiology from the Massachusetts Institute of Technology (LCP-MIT) who work to keep the MIMIC-III and eICU databases available and who organized the MIT-Datathon in São Paulo, Brazil.

Authors’ contributions

ASN designed the study, conducted the data collection, data analysis, and data interpretation, and wrote the manuscript. ROC conducted the data collection, the data interpretation, and reviewed the manuscript. AEWJ conducted the data collection, the data interpretation, and reviewed the manuscript. LDB conducted the data collection, the data interpretation, and reviewed the manuscript. PA designed the study, conducted the data collection, and reviewed the manuscript. SMP designed the study, conducted the data collection, and reviewed the manuscript. DCC designed the study and reviewed the manuscript. RLC designed the study and reviewed the manuscript. TDC designed the study and reviewed the manuscript. GPPS designed the study and reviewed the manuscript. KTT designed the study and reviewed the manuscript. PP designed the study, conducted the data interpretation, and reviewed the manuscript. MGA designed the study, conducted the data interpretation, and reviewed the manuscript. MJS designed the study, conducted the data interpretation, and reviewed the manuscript.

Compliance with ethical standards

Conflicts of interest

The authors declared that they have no conflict of interest.

Supplementary material

134_2018_5375_MOESM1_ESM.docx (6.6 mb)
Supplementary material 1 (DOCX 6797 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Ary Serpa Neto
    • 1
    • 2
    • 3
  • Rodrigo Octavio Deliberato
    • 2
    • 3
    • 4
  • Alistair E. W. Johnson
    • 5
  • Lieuwe D. Bos
    • 1
  • Pedro Amorim
    • 6
  • Silvio Moreto Pereira
    • 6
  • Denise Carnieli Cazati
    • 2
  • Ricardo L. Cordioli
    • 2
  • Thiago Domingos Correa
    • 2
  • Tom J. Pollard
    • 5
  • Guilherme P. P. Schettino
    • 2
  • Karina T. Timenetsky
    • 2
  • Leo A. Celi
    • 5
    • 7
  • Paolo Pelosi
    • 8
    • 9
  • Marcelo Gama de Abreu
    • 10
  • Marcus J. Schultz
    • 1
    • 11
  • for the PROVE Network Investigators
  1. 1.Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA)Academic Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Critical Care MedicineHospital Israelita Albert EinsteinSão PauloBrazil
  3. 3.Laboratory for Critical Care ResearchHospital Israelita Albert EinsteinSão PauloBrazil
  4. 4.Big Data Analytics GroupHospital Israelita Albert EinsteinSão PauloBrazil
  5. 5.Laboratory for Computational PhysiologyInstitute for Medical Engineering and Science, MITCambridgeUSA
  6. 6.Department of InnovationHospital Israelita Albert EinsteinSão PauloBrazil
  7. 7.Division of Pulmonary, Critical Care and Sleep MedicineBeth Israel Deaconess Medical CenterBostonUSA
  8. 8.Department of Surgical Sciences and Integrated DiagnosticsSan Martino Policlinico Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) for OncologyGenoaItaly
  9. 9.Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
  10. 10.Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care MedicineUniversity Hospital Carl Gustav Carus, Technische Universität DresdenDresdenGermany
  11. 11.Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical MedicineMahidol UniversityBangkokThailand

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