Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts
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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.
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.
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.
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.
KeywordsMechanical ventilation Mechanical power Mortality Critically ill Intensive care unit Ventilator-induced lung injury
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.
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.
- 2.Cressoni M, Gotti M, Chiurazzi C, Massari D, Algieri I, Amini M, Cammaroto A, Brioni M, Montaruli C, Nikolla K, Guanziroli M, Dondossola D, Gatti S, Valerio V, Vergani GL, Pugni P, Cadringher P, Gagliano N, Gattinoni L (2016) Mechanical power and development of ventilator-induced lung injury. Anesthesiology 124:1100–1108CrossRefGoogle Scholar
- 9.Maia LA, Samary CS, Oliveira MV, Santos CL, Huhle R, Capelozzi VL, Morales MM, Schultz MJ, Abreu MG, Pelosi P, Silva PL, Rocco PRM (2017) Impact of different ventilation strategies on driving pressure, mechanical power, and biological markers during open abdominal surgery in rats. Anesth Analg 125:1364–1374CrossRefGoogle Scholar
- 10.Serpa Neto A, Deliberato RO, Johnson AEW, Amorim P, Pereira SM, Cazati DC, Coridoli RL, Correa TD, Coutinho E, Schettino GPP, Timenetsky KT, Pelosi P, Gama de Abreu M, Schultz MJ (2017) Mechanical power during mechanical ventilation of critically ill patients. J Crit Care 42:392Google Scholar
- 14.ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533Google Scholar
- 16.De Jong A, Cossic J, Verzilli D, Monet C, Carr J, Conseil M, Monnin M, Cisse M, Belafia F, Molinari N, Chanques G, Jaber S (2018) Impact of the driving pressure on mortality in obese and non-obese ARDS patients: a retrospective study of 362 cases. Intensive Care Med 47:453–463Google Scholar
- 17.Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, Ranieri M, Rubenfeld G, Thompson BT, Wrigge H, Slutsky AS, Pesenti A, LUNG SAFE Investigators, ESICM Trials Group (2016) Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 315:788–800CrossRefGoogle Scholar
- 18.Neto AS, Barbas CSV, Simonis FD, Artigas-Raventós A, Canet J, Determann RM, Anstey J, Hedenstierna G, Hemmes SNT, Hermans G, Hiesmayr M, Hollmann MW, Jaber S, Martin-Loeches I, Mills GH, Pearse RM, Putensen C, Schmid W, Severgnini P, Smith R, Treschan TA, Tschernko EM, Melo MFV, Wrigge H, de Abreu MG, Pelosi P, Schultz MJ, PRoVENT, PROVE Network Investigators (2016) Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study. Lancet Respir Med 4:882–893CrossRefGoogle Scholar
- 23.Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Espósito DC, Pasqualucci Mde O, Damasceno MC, Schultz MJ (2012) Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA 308:1651–1659CrossRefGoogle Scholar
- 24.Briel M, Meade M, Mercat A, Brower RG, Talmor D, Walter SD, Slutsky AS, Pullenayegum E, Zhou Q, Cook D, Brochard L, Richard JC, Lamontagne F, Bhatnagar N, Stewart TE, Guyatt G (2010) Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and meta-analysis. JAMA 303:865–873CrossRefGoogle Scholar
- 25.Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators, Cavalcanti AB, Suzumura ÉA, Laranjeira LN, Paisani DM, Damiani LP, Guimarães HP, Romano ER, Regenga MM, Taniguchi LNT, Teixeira C, Pinheiro de Oliveira R, Machado FR, Diaz-Quijano FA, Filho MSA, Maia IS, Caser EB, Filho WO, Borges MC, Martins PA, Matsui M, Ospina-Tascón GA, Giancursi TS, Giraldo-Ramirez ND, Vieira SRR, Assef MDGPL, Hasan MS, Szczeklik W, Rios F, Amato MBP, Berwanger O, Ribeiro de Carvalho CR (2017) Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA 318:1335–1345CrossRefGoogle Scholar
- 27.Neto AS, Hemmes SN, Barbas CS, Beiderlinden M, Fernandez-Bustamante A, Futier E, Gajic O, El-Tahan MR, Ghamdi AA, Günay E, Jaber S, Kokulu S, Kozian A, Licker M, Lin WQ, Maslow AD, Memtsoudis SG, Reis Miranda D, Moine P, Ng T, Paparella D, Ranieri VM, Scavonetto F, Schilling T, Selmo G, Severgnini P, Sprung J, Sundar S, Talmor D, Treschan T, Unzueta C, Weingarten TN, Wolthuis EK, Wrigge H, Amato MB, Costa EL, de Abreu MG, Pelosi P, Schultz MJ, PROVE Network Investigators (2016) Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med 4:272–280CrossRefGoogle Scholar
- 28.Santos RS, Maia LA, Oliveira MV, Santos CL, Moraes L, Pinto EF, Samary CDS, Machado JA, Carvalho AC, Fernandes MVS, Martins V, Capelozzi VL, Morales MM, Koch T, Gama de Abreu M, Pelosi P, Silva PL, Rocco PRM (2018) Biologic impact of mechanical power at high and low tidal volumes in experimental mild acute respiratory distress syndrome. Anesthesiology 128:1193–1206CrossRefGoogle Scholar