Eduardo L V Costa1,2, Arthur S Slutsky3,4, Laurent J Brochard3,4, Roy Brower5, Ary Serpa-Neto6, Alexandre B Cavalcanti7, Alain Mercat8, Maureen Meade9, Caio C A Morais1, Ewan Goligher3,10,11, Carlos R R Carvalho1, Marcelo B P Amato1. 1. Laboratório de Pneumologia, Laboratório de Investigação Médica 09, Disciplina de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil. 2. Instituto de Ensino e Pesquisa, Hospital Sírio-Libanes, São Paulo, São Paulo, Brazil. 3. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. 4. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 5. Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland. 6. Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil. 7. Instituto de Pesquisas Hospital do Coração-Hospital do Coração, São Paulo, São Paulo, Brazil. 8. Département de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France. 9. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 10. Division of Respirology, Department of Medicine, University Health Network and Sinai Health System, Toronto, Ontario, Canada; and. 11. Toronto General Hospital Research Institute, Toronto General Hospital, Toronto, Ontario, Canada.
Abstract
Rationale: Mortality in acute respiratory distress syndrome (ARDS) has decreased after the adoption of lung-protective strategies. Lower Vt, lower driving pressure (ΔP), lower respiratory rates (RR), and higher end-expiratory pressure have all been suggested as key components of lung protection strategies. A unifying theoretical explanation has been proposed that attributes lung injury to the energy transfer rate (mechanical power) from the ventilator to the patient, calculated from a combination of several ventilator variables. Objectives: To assess the impact of mechanical power on mortality in patients with ARDS as compared with that of primary ventilator variables such as the ΔP, Vt, and RR. Methods: We obtained data on ventilatory variables and mechanical power from a pooled database of patients with ARDS who had participated in six randomized clinical trials of protective mechanical ventilation and one large observational cohort of patients with ARDS. The primary outcome was mortality at 28 days or 60 days.Measurements and Main Results: We included 4,549 patients (38% women; mean age, 55 ± 23 yr). The average mechanical power was 0.32 ± 0.14 J · min-1 · kg-1 of predicted body weight, the ΔP was 15.0 ± 5.8 cm H2O, and the RR was 25.7 ± 7.4 breaths/min. The driving pressure, RR, and mechanical power were significant predictors of mortality in adjusted analyses. The impact of the ΔP on mortality was four times as large as that of the RR.Conclusions: Mechanical power was associated with mortality during controlled mechanical ventilation in ARDS, but a simpler model using only the ΔP and RR was equivalent.
Rationale: Mortality in acute respiratory distress syndrome (ARDS) has decreased after the adoption of lung-protective strategies. Lower Vt, lower driving pressure (ΔP), lower respiratory rates (RR), and higher end-expiratory pressure have all been suggested as key components of lung protection strategies. A unifying theoretical explanation has been proposed that attributes lung injury to the energy transfer rate (mechanical power) from the ventilator to the patient, calculated from a combination of several ventilator variables. Objectives: To assess the impact of mechanical power on mortality in patients with ARDS as compared with that of primary ventilator variables such as the ΔP, Vt, and RR. Methods: We obtained data on ventilatory variables and mechanical power from a pooled database of patients with ARDS who had participated in six randomized clinical trials of protective mechanical ventilation and one large observational cohort of patients with ARDS. The primary outcome was mortality at 28 days or 60 days.Measurements and Main Results: We included 4,549 patients (38% women; mean age, 55 ± 23 yr). The average mechanical power was 0.32 ± 0.14 J · min-1 · kg-1 of predicted body weight, the ΔP was 15.0 ± 5.8 cm H2O, and the RR was 25.7 ± 7.4 breaths/min. The driving pressure, RR, and mechanical power were significant predictors of mortality in adjusted analyses. The impact of the ΔP on mortality was four times as large as that of the RR.Conclusions: Mechanical power was associated with mortality during controlled mechanical ventilation in ARDS, but a simpler model using only the ΔP and RR was equivalent.
Authors: Anoopindar K Bhalla; Margaret J Klein; Vicent Modesto I Alapont; Guillaume Emeriaud; Martin C J Kneyber; Alberto Medina; Pablo Cruces; Franco Diaz; Muneyuki Takeuchi; Aline B Maddux; Peter M Mourani; Cristina Camilo; Benjamin R White; Nadir Yehya; John Pappachan; Matteo Di Nardo; Steven Shein; Christopher Newth; Robinder Khemani Journal: Crit Care Date: 2022-01-03 Impact factor: 9.097
Authors: Katherine D Wick; Daniel F McAuley; Joseph E Levitt; Jeremy R Beitler; Djillali Annane; Elisabeth D Riviello; Carolyn S Calfee; Michael A Matthay Journal: Crit Care Date: 2021-11-23 Impact factor: 19.334
Authors: Joseph E Tonna; Ithan D Peltan; Samuel M Brown; Colin K Grissom; Angela P Presson; Jennifer S Herrick; Francesco Vasques; Heather T Keenan Journal: Crit Care Explor Date: 2021-12-09
Authors: Francesco Zadek; Jonah Rubin; Luigi Grassi; Daniel Van Den Kroonenberg; Grant Larson; Martin Capriles; Roberta De Santis Santiago; Gaetano Florio; David A Imber; Edward A Bittner; Kathryn A Hibbert; Alex Legassey; Jeliene LaRocque; Gaston Cudemus-Deseda; Aranya Bagchi; Jerome Crowley; Kenneth Shelton; Robert Kacmarek; Lorenzo Berra Journal: Crit Care Explor Date: 2021-06-29
Authors: Adnan Liaqat; Matthew Mason; Brian J Foster; Sagar Kulkarni; Aisha Barlas; Awais M Farooq; Pooja Patak; Hamza Liaqat; Rafaela G Basso; Mohammed S Zaman; Dhaval Pau Journal: J Clin Med Date: 2022-01-10 Impact factor: 4.241
Authors: Dharshi Karalapillai; Laurence Weinberg; Serpa Neto A; Philip Peyton; Louise Ellard; Raymond Hu; Brett Pearce; Chong O Tan; David Story; Mark O'Donnell; Patrick Hamilton; Chad Oughton; Jonathan Galtieri; Anthony Wilson; Glenn Eastwood; Rinaldo Bellomo; Daryl A Jones Journal: Eur J Anaesthesiol Date: 2022-01-01 Impact factor: 4.330