Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation

Abstract

Prolonged mechanical ventilation (PMV) after lung transplantation poses several risks, including higher tracheostomy rates and increased in-hospital mortality. Mechanical power (MP) of artificial ventilation unifies the ventilatory variables that determine gas exchange and may be related to allograft function following transplant, affecting ventilator weaning. We retrospectively analyzed consecutive double lung transplant recipients at a national transplant center, ventilated through endotracheal tubes upon ICU admission, excluding those receiving extracorporeal support. MP and derived indexes assessed up to 36 h after transplant were correlated with invasive ventilation duration using Spearman’s coefficient, and we conducted receiver operating characteristic (ROC) curve analysis to evaluate the accuracy in predicting PMV (>72 h), expressed as area under the ROC curve (AUROC). PMV occurred in 82 (35%) out of 237 cases. MP was significantly correlated with invasive ventilation duration (Spearman’s ρ = 0.252 [95% CI 0.129–0.369], p < 0.01), with power density (MP normalized to lung-thorax compliance) demonstrating the strongest correlation (ρ = 0.452 [0.345–0.548], p < 0.01) and enhancing PMV prediction (AUROC 0.78 [95% CI 0.72–0.83], p < 0.01) compared to MP (AUROC 0.66 [0.60–0.72], p < 0.01). Mechanical power density may help identify patients at risk for PMV after double lung transplantation.

Mechanical power density, spontaneous breathing indexes, and prolonged weaning failure: a prospective cohort study

“…This index incorporates respiratory rate and airway pressures, factors that also have been independently associated with weaning failure in the recent multicenter WEAN SAFE study 21 . MP density has also been shown to be an accurate predictor of prolonged ventilation after double lung transplantation, with LTC dyn -MP demonstrating the strongest correlation with invasive ventilation time following a patient’s transfer from the operating room to the ICU 22 . However, further research is required as other studies have demonstrated conflicting findings 23 .…”