Mean Airway Pressure As a Predictor of 90-Day Mortality in Mechanically Ventilated Patients*

Abstract

Objectives: To determine the association between mean airway pressure and 90-day mortality in patients with acute respiratory failure requiring mechanical ventilation and to compare the predictive ability of mean airway pressure compared with inspiratory plateau pressure and driving pressure. Design: Prospective observational cohort. Setting: Five ICUs in Lima, Peru. Subjects: Adults requiring invasive mechanical ventilation via endotracheal tube for acute respiratory failure. Interventions: None. Measurements and Main Results: Of potentially eligible participants (n = 1,500), 65 (4%) were missing baseline mean airway pressure, while 352 (23.5%) were missing baseline plateau pressure and driving pressure. Ultimately, 1,429 participants were included in the analysis with an average age of 59 ± 19 years, 45% female, and a mean Pao 2/Fio 2 ratio of 248 ± 147 mm Hg at baseline. Overall, 90-day mortality was 50.4%. Median baseline mean airway pressure was 13 cm H2O (interquartile range, 10–16 cm H2O) in participants who died compared to a median mean airway pressure of 12 cm H2O (interquartile range, 10–14 cm H2O) in participants who survived greater than 90 days (p < 0.001). Mean airway pressure was independently associated with 90-day mortality (odds ratio, 1.38 for difference comparing the 75th to the 25th percentile for mean airway pressure; 95% CI, 1.10–1.74) after adjusting for age, sex, baseline Acute Physiology and Chronic Health Evaluation III, baseline Pao 2/Fio 2 (modeled with restricted cubic spline), baseline positive end-expiratory pressure, baseline tidal volume, and hospital site. In predicting 90-day mortality, baseline mean airway pressure demonstrated similar discriminative ability (adjusted area under the curve = 0.69) and calibration characteristics as baseline plateau pressure and driving pressure. Conclusions: In a multicenter prospective cohort, baseline mean airway pressure was independently associated with 90-day mortality in mechanically ventilated participants and predicts mortality similarly to plateau pressure and driving pressure. Because mean airway pressure is readily available on all mechanically ventilated patients and all ventilator modes, it is a potentially more useful predictor of mortality in acute respiratory failure.

Early prediction of noninvasive ventilation failure after extubation: development and validation of a machine-learning model

“…It may be consistent with those from previous studies showing that early use NIV is associated with a significant reduction of post-extubation respiratory failure [19,25]. However, this finding must be validated in further prospective studies [14][15][16][17][18]21].…”

“…Pressure of oxygen in blood (PaO 2 ) means the tension created by the oxygen physically dissolving in the blood, which is assessed during blood gas analysis. Mean airway pressure (Pmean), showed on the ventilator, determined by the peak inspiratory pressure (PIP), PEEP, and the inspiratory to expiratory time ratio [ 15 ]. The mean airway pressure was measured for NIV within 6 h of initiation.…”

Mean airway pressure has the potential to become the core pressure indicator of mechanical ventilation: Raising to the front from behind the clinical scenes

“…Taken together, Pmean is a potential indicator of lung stress. A recent multicenter study showed that in a group of mechanically ventilated ARDS patients, Pmean was independently associated with 90-day mortality and correlated with Pplat or Pdriv, which had predicted mortality like the implication of Pplat or Pdriv [8] . From this point of view, Pmean also has potential prompt significance when spontaneous breathing is too strong or breathing drive is too high.…”

Novel Oxygenation and Saturation Indices for Mortality Prediction in COVID-19 ARDS Patients: The Impact of Driving Pressure and Mechanical Power

“…The critical values associated with intensive care mortality for various pressures and mechanical power parameters (P mean ; 17 cmH 2 O, P peak ; 26 cmH 2 O, ΔP insp ; 15 cmH 2 O, PEEP; 9.3 cmH 2 O, MP tot ; 17 j/min) were found to align with previously published studies, supporting the clinical relevance of these thresholds. 21,[43][44][45] Notably, patients who remained in the prone position for more than 15.5 h per day exhibited a lower rate of intensive care mortality. This observation corresponds with findings from other investigations, which have reported reduced mortality rates in patients who spent more than 16 h per day in the prone position.…”