Mechanical power is associated with weaning outcome in critically ill mechanically ventilated patients

Yao, Yan; Xie, Yongpeng; Chen, Xiaobing; Sun, Yan; Du, Zhiqiang; Wang, Yanli; Li, Xiaomin

doi:10.1038/s41598-022-21609-2

Cited by 4 publications

(10 citation statements)

References 33 publications

(53 reference statements)

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“…In the present analysis, power density (mechanical stress intensity) outperformed mechanical power in correlating with invasive ventilation duration and predicting PMV. Power density (e.g., LTC dyn -MP) mainly depends on airway pressure and respiratory rate, and current data suggest that these parameters are most relevant in determining whether a patient will require a prolonged course of ventilation [ 4 , 29 ] or even be unable to wean off the ventilator [ 7 , 34 ]. Accordingly, in the present analysis, airway pressures and respiratory rate but not PBW-adjusted tidal volumes significantly differed between PMV and non-PMV subjects.…”

Section: Discussionmentioning

confidence: 99%

“…During artificial ventilation, MP is the pressure-volume work per minute provided by the ventilator, as determined by respiratory rate, tidal volume, and applied airway pressure. To account for lung dimensions interacting with MP, we normalized power to the recipients’ predicted body weight (PBW-MP) [ 21 ] and LTC dyn (LTC dyn -MP) [ 7 , 8 ]. PBW correlates with the total lung capacity of a healthy individual.…”

Section: Methodsmentioning

confidence: 99%

“…PBW correlates with the total lung capacity of a healthy individual. Dynamic compliance with its temporal changes is a surrogate of ventilated lung volume, accounting for the force required to overcome the respiratory system’s resistance and elastance, which is critical during ventilator weaning [ 7 , 8 ].…”

Section: Methodsmentioning

confidence: 99%

“…Mechanical power (MP) of artificial ventilation [ 6 ], equal to the displacement work performed by the ventilator per minute, unifies the ventilatory variables that determine oxygenation (e.g., positive end-expiratory pressure) and decarboxylation (e.g., minute ventilation) and thus may be related to allograft function during the early postoperative period. Previous research indicates that MP may predict weaning outcomes in mechanically ventilated critically ill patients, with failure patients experiencing consistently longer invasive ventilation periods [ 7 , 8 ]. Accordingly, we hypothesized that MP would be equally effective in predicting weaning outcomes following lung transplantation.…”

Section: Introductionmentioning

confidence: 99%

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Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation

Ghiani,

Kneidinger,

Neurohr

et al. 2023

Transpl Int

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation

Ghiani,

Kneidinger,

Neurohr

et al. 2023

Transpl Int

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“…where A sa_untreated is the alveolar surface area before CPAP is applied; FRC is the functional residual lung capacity, and it is assumed that most respiration will occur at this lung volume; CPAP is the pressure applied; C lung is the static lung compliance considered to be constant for non-atelectatic or nondistended lungs. Only the lung compliance is considered and assumed be approximately 40 mL/cm H 2 O [2]. The chest wall compliance is not considered when computing the relative increase in alveolar surface area.…”

Section: Fick's Lawmentioning

confidence: 99%

Optimizing Tracheal Oxygen Tension and Diffusion Ratio When Choosing High-Flow Oxygen Therapy or CPAP for the Treatment of Hypoxemic Respiratory Failure: Insights from Ex Vivo Physiologic Modelling

Truschel¹,

Polkey

2023

JCM

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This article is a review of the physiological and technological processes underpinning high-flow nasal therapy with oxygen (HFNT or HFOT) for the treatment of hypoxemic respiratory failure. A mathematical model was carefully built to represent the relationships between the settings on the HFNT device and the resultant diffusion of oxygen into hypoxemic, arterial blood. The analysis was used to recommend a strategy for setting the flow rate at or above the patient’s peak inspiratory flow when HFNT is used with a blender and equal to the patient’s peak inspiratory rate when bleed-in oxygen is used. The analysis also teaches how to titrate the settings to achieve a desired fraction of inhaled oxygen, (FiO2), in the trachea using a simple ratio when bleed-in oxygen is used. The model was used to compare HFNT as a method to improve oxygen diffusion efficacy with other forms of oxygen therapy. The analysis in this article relates the efficacy of HFOT/HFNT to that of CPAP with supplemental oxygen by computing the diffusion ratio of oxygen therapy versus breathing room air. We predicted that in non-atelectatic lungs, when considering oxygenation, HFNT can be equally effective as CPAP with supplemental oxygen therapy for treating hypoxemic respiratory failure.

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Retrospective analysis of factors associated with outcome in veno-venous extra-corporeal membrane oxygenation

Orthmann

Ltaief²,

Bonnemain³

et al. 2023

BMC Pulm Med

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Background The outcome of Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) in acute respiratory failure may be influenced by patient-related factors, center expertise and modalities of mechanical ventilation (MV) during ECMO. We determined, in a medium-size ECMO center in Switzerland, possible factors associated with mortality during VV-ECMO for acute respiratory failure of various etiologies. Methods We retrospectively analyzed all patients treated with VV-ECMO in our University Hospital from 2012 to 2019 (pre-COVID era). Demographic variables, severity scores, MV duration before ECMO, pre and on-ECMO arterial blood gases and respiratory variables were collected. The primary outcome was ICU mortality. Data were compared between survivors and non-survivors, and factors associated with mortality were assessed in univariate and multivariate analyses. Results Fifty-one patients (33 ARDS, 18 non-ARDS) were included. ICU survival was 49% (ARDS, 39%; non-ARDS 67%). In univariate analyses, a higher driving pressure (DP) at 24h and 48h on ECMO (whole population), longer MV duration before ECMO and higher DP at 24h on ECMO (ARDS patients), were associated with mortality. In multivariate analyses, ECMO indication, higher DP at 24h on ECMO and, in ARDS, longer MV duration before ECMO, were independently associated with mortality. Conclusions DP on ECMO and longer MV duration before ECMO (in ARDS) are major, and potentially modifiable, factors influencing outcome during VV-ECMO.

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Mechanical power is associated with weaning outcome in critically ill mechanically ventilated patients

Cited by 4 publications

References 33 publications

Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation

Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation

Optimizing Tracheal Oxygen Tension and Diffusion Ratio When Choosing High-Flow Oxygen Therapy or CPAP for the Treatment of Hypoxemic Respiratory Failure: Insights from Ex Vivo Physiologic Modelling

Retrospective analysis of factors associated with outcome in veno-venous extra-corporeal membrane oxygenation

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