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