Twenty-four-hour mechanical power variation rate is associated with mortality among critically ill patients with acute respiratory failure: a retrospective cohort study

Yi Chi, Qing Zhang, Siyi Yuan, Zhanqi Zhao, Yun Long, Huaiwu He, Yi Chi, Qing Zhang, Siyi Yuan, Zhanqi Zhao, Yun Long, Huaiwu He

Abstract

Objectives: Defined as the energy applied to the respiratory system by ventilator, mechanical power (MP) of ventilation reflects the risk of ventilation-induced lung injury. This study aims to explore the relationship between dynamic changes in MP and prognosis in critically ill patients.

Methods: This was a single-centre retrospective cohort study. Patients receiving mechanical ventilation with acute respiratory failure (ARF) and MP > 10 J/min on admission in the ICU were included. MP (J/min) was calculated as 0.098 × minute ventilation (L/min) × [(peak inspiratory pressure + positive end-expiratory pressure)/2] and the MP variation rate (%) as ([baseline MP - 24-h MP]/baseline MP) × 100. Patients were divided into two groups according to whether MP decreased 24 h after admission (MP-improved group defined as 24-h MP variation rate > 0% vs. MP-worsened group defined as 24-h MP variation rate ≤ 0%).

Results: In total, 14,463 patients were screened between January 2015 and June 2020, and finally, a study cohort of 602 patients was obtained. The MP-improved group had a lower ICU mortality rate than the MP-worsened group (24% vs. 36%; p = 0.005). The 24-h MP variation rate was associated with ICU mortality after adjusting for confounders (odds ratio, 0.906 [95% CI 0.833-0.985]; p = 0.021), while baseline MP (p = 0.909) and 24-h MP (p = 0.059) were not. All MP components improved in the MP-improved group, while minute ventilation and positive end-expiratory pressure contributed to the increase in MP in the MP-worsened group.

Conclusions: The 24-h MP variation rate was an independent risk factor for ICU mortality among ARF patients with elevated MP. Early decreases in MP may provide prognostic benefits in this population.

Keywords: Acute respiratory failure; Mechanical power; Mortality; Prognosis.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
A flowchart of patient inclusion and exclusion
Fig. 2
Fig. 2
Cumulative incidence curves of discontinuation of mechanical ventilation over time (Gray-test p = 0.0026) with death as competing event according to the change of mechanical power (MP)

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Source: PubMed

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