Acute Crit Care.  2024 Feb;39(1):91-99. 10.4266/acc.2023.00871.

Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation

• Sim JK
• Lee SM
• Kang HK
• Kim KC
• Kim YS
• Kim YS
• Lee WY
• Park S
• Park SY
• Park JH
• Sim YS
• Lee K
• Lee YJ
• Lee JH
• Lee HB
• Lim CM
• Choi WI
• Hong JY
• Song WJ
• Suh GY

• KMID: 2555227
• DOI: http://doi.org/10.4266/acc.2023.00871

Abstract

Background
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality. Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579). Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.

Keyword

artificial respiration; intensive care unit; mechanical ventilators; mortality

Figure

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  Figure 1. Study flowchart. PCV: pressure-controlled ventilation; ICU: intensive care unit.

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