Comparison of mechanical power estimations in mechanically ventilated patients with ARDS: a secondary data analysis from the EPVent study

Schaefer, Maximilian S.; Loring, Stephen H.; Talmor, Daniel; Baedorf‐Kassis, Elias N.

doi:10.1007/s00134-020-06282-1

Cited by 14 publications

(15 citation statements)

References 5 publications

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“…We found that only the dynamic elastic component was associated with greater risk of postoperative reintubation, but the static and dynamic resistive components were not. The isolation of this dynamic elastic element of mechanical power 15,41 reflects previous reports in patients with acute ARDS 19 and supports the need for further adjustment of the concept when estimating ventilator-induced lung injury, 42 for example by reducing noise from including the energy required to overcome airway resistance and elastic lung recoil. 15…”

Section: Discussionsupporting

confidence: 75%

“…11 The concept integrates ventilator-delivered inspiratory work, calculated from inspiratory pressures and tidal volume, and cyclic repetition, derived from respiratory rate. 15 It further allows physicians to assess adjustments to mechanical ventilation by calculating a single value. A post hoc analysis 16 of the aforementioned randomized controlled trial 6 conducted in response to an accompanying letter 9 found that while there was no effect of low versus high tidal volumes, a higher mechanical power during ventilation was associated with a greater risk of postoperative pulmonary complications.…”

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confidence: 99%

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Mechanical Power during General Anesthesia and Postoperative Respiratory Failure: A Multicenter Retrospective Cohort Study

et al. 2022

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Background Mechanical power during ventilation estimates the energy delivered to the respiratory system through integrating inspiratory pressures, tidal volume, and respiratory rate into a single value. It has been linked to lung injury and mortality in the acute respiratory distress syndrome, but little evidence exists regarding whether the concept relates to lung injury in patients with healthy lungs. This study hypothesized that higher mechanical power is associated with greater postoperative respiratory failure requiring reintubation in patients undergoing general anesthesia. Methods In this multicenter, retrospective study, 230,767 elective, noncardiac adult surgical out- and inpatients undergoing general anesthesia between 2008 and 2018 at two academic hospital networks in Boston, Massachusetts, were included. The risk-adjusted association between the median intraoperative mechanical power, calculated from median values of tidal volume (Vt), respiratory rate (RR), positive end-expiratory pressure (PEEP), plateau pressure (Pplat), and peak inspiratory pressure (Ppeak), using the following formula: mechanical power (J/min) = 0.098 × RR × Vt × (PEEP + ½[Pplat – PEEP] + [Ppeak − Pplat]), and postoperative respiratory failure requiring reintubation within 7 days, was assessed. Results The median intraoperative mechanical power was 6.63 (interquartile range, 4.62 to 9.11) J/min. Postoperative respiratory failure occurred in 2,024 (0.9%) patients. The median (interquartile range) intraoperative mechanical power was higher in patients with postoperative respiratory failure than in patients without (7.67 [5.64 to 10.11] vs. 6.62 [4.62 to 9.10] J/min; P < 0.001). In adjusted analyses, a higher mechanical power was associated with greater odds of postoperative respiratory failure (adjusted odds ratio, 1.31 per 5 J/min increase; 95% CI, 1.21 to 1.42; P < 0.001). The association between mechanical power and postoperative respiratory failure was robust to additional adjustment for known drivers of ventilator-induced lung injury, including tidal volume, driving pressure, and respiratory rate, and driven by the dynamic elastic component (adjusted odds ratio, 1.35 per 5 J/min; 95% CI, 1.05 to 1.73; P = 0.02). Conclusions Higher mechanical power during ventilation is statistically associated with a greater risk of postoperative respiratory failure requiring reintubation. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Discussionsupporting

confidence: 75%

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confidence: 99%

Mechanical Power during General Anesthesia and Postoperative Respiratory Failure: A Multicenter Retrospective Cohort Study

et al. 2022

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“…However, PEEP is a set parameter on the ventilator based on the physician's choice and the lowest and highest levels of PEEP are associated with mortality in ARDS. 84 In addition, different levels of PEEP are associated with a different potential for lung recruitment. 85 Thus, the use of PEEP to adjust PaO 2 /FiO 2 in the context of lung injury severity monitoring needs better clarification.…”

Section: Oxygenationmentioning

confidence: 99%

“…The authors advocate the potential complex association of PEEP with VILI, according to the opposite predisposing condition of atelectasis versus overdistension at lower and higher PEEP levels, respectively. 84…”

Section: Variables Related To Ventilation Intensitymentioning

confidence: 99%

Monitoring Lung Injury Severity and Ventilation Intensity during Mechanical Ventilation

Rezoagli

Laffey

Bellani

2022

Semin Respir Crit Care Med

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Acute respiratory distress syndrome (ARDS) is a severe form of respiratory failure burden by high hospital mortality. No specific pharmacologic treatment is currently available and its ventilatory management is a key strategy to allow reparative and regenerative lung tissue processes. Unfortunately, a poor management of mechanical ventilation can induce ventilation induced lung injury (VILI) caused by physical and biological forces which are at play. Different parameters have been described over the years to assess lung injury severity and facilitate optimization of mechanical ventilation. Indices of lung injury severity include variables related to gas exchange abnormalities, ventilatory setting and respiratory mechanics, ventilation intensity, and the presence of lung hyperinflation versus derecruitment. Recently, specific indexes have been proposed to quantify the stress and the strain released over time using more comprehensive algorithms of calculation such as the mechanical power, and the interaction between driving pressure (DP) and respiratory rate (RR) in the novel DP multiplied by four plus RR [(4 × DP) + RR] index. These new parameters introduce the concept of ventilation intensity as contributing factor of VILI. Ventilation intensity should be taken into account to optimize protective mechanical ventilation strategies, with the aim to reduce intensity to the lowest level required to maintain gas exchange to reduce the potential for VILI. This is further gaining relevance in the current era of phenotyping and enrichment strategies in ARDS.

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“…A measure that aims to integrate static and dynamic parameters of ventilation is mechanical power, which estimates the energy per minute that is applied to the respiratory system . Although controversies still exist regarding its computation, high mechanical power has been associated with increased lung injury and mortality …”

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confidence: 99%

Effect of Tidal Volume on Pulmonary Outcomes After Surgery

Schaefer

Talmor

Baedorf‐Kassis

2021

JAMA

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Comparison of mechanical power estimations in mechanically ventilated patients with ARDS: a secondary data analysis from the EPVent study

Cited by 14 publications

References 5 publications

Mechanical Power during General Anesthesia and Postoperative Respiratory Failure: A Multicenter Retrospective Cohort Study

Mechanical Power during General Anesthesia and Postoperative Respiratory Failure: A Multicenter Retrospective Cohort Study

Monitoring Lung Injury Severity and Ventilation Intensity during Mechanical Ventilation

Effect of Tidal Volume on Pulmonary Outcomes After Surgery

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