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Annual Update in Intensive Care and Emergency Medicine 2020 pp 37–50Cite as

Ten Reasons to Use Mechanical Power to Guide Ventilator Settings in Patients Without ARDS

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Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

Abstract

Mechanical ventilation is a life-support system used in many environments, including the emergency department, operating room, and intensive care unit (ICU). The monitoring of respiratory mechanics has received much attention recently. In this context, tidal volume, respiratory rate and respiratory system plateau (P plat) and driving (ΔP) pressures are the ventilator variables classically assessed and reported in clinical trials. However, when analyzed separately, they are not associated with inhospital mortality in patients without the acute respiratory distress syndrome (ARDS). On the other hand, mechanical power, which represents the amount of energy transferred from the mechanical ventilator to the respiratory system over time, is demonstrably associated with inhospital mortality. Mechanical power is calculated by the combination of tidal volume, respiratory rate, P plat, and ΔP. Recent advances have been made in the calculation of mechanical power, not only in volume-controlled but also in pressure-controlled ventilation, in critically ill patients. These advances rely on the computation of the elastic and resistive components of mechanical power, as well as on the computation of mechanical power during assisted breaths. In this chapter, we list ten reasons why mechanical power should be monitored as a tool to guide ventilator strategies in patients without ARDS. We believe that the development of algorithms for embedding in mechanical ventilators and the provision of real-time information on mechanical power could help physicians better guide their ventilator strategies in patients without ARDS.

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Author information

Authors and Affiliations

  1. Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    P. L. Silva & P. R. M. Rocco

  2. Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy

    P. Pelosi

  3. IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy

    P. Pelosi

Authors
  1. P. L. Silva
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  2. P. R. M. Rocco
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  3. P. Pelosi
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Corresponding author

Correspondence to P. Pelosi .

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Editors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

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Silva, P.L., Rocco, P.R.M., Pelosi, P. (2020). Ten Reasons to Use Mechanical Power to Guide Ventilator Settings in Patients Without ARDS. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2020. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-37323-8_3

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  • DOI: https://doi.org/10.1007/978-3-030-37323-8_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-37322-1

  • Online ISBN: 978-3-030-37323-8

  • eBook Packages: MedicineMedicine (R0)

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