Comprehensive study of mechanical power in controlled mechanical ventilation: Prevalence of elevated mechanical power and component analysis

Abstract

Objective

To determine the prevalence of elevated mechanical power (MP) values (>17 J/min) used in routine clinical practice.

Design

Observational, descriptive, cross-sectional, analytical, multicenter, international study conducted on November 21, 2019, from 8:00 AM to 3:00 PM. NCT03936231.

Setting

One hundred thirty-three Critical Care Units.

Patients

Patients receiving invasive mechanical ventilation for any cause.

Interventions

None.

Main variables of interest

Mechanical power.

Results

A population of 372 patients was analyzed. PM was significantly higher in patients under pressure-controlled ventilation (PC) compared to volume-controlled ventilation (VC) (19.20 ± 8.44 J/min vs. 16.01 ± 6.88 J/min; p < 0.001), but the percentage of patients with PM > 17 J/min was not different (41% vs. 35%, respectively; p = 0.382). The best models according to AICcw expressing PM for patients in VC are described as follows: Surrogate Strain (Driving Pressure) + PEEP + Surrogate Strain Rate (PEEP/Flow Ratio) + Respiratory Rate. For patients in PC, it is defined as: Surrogate Strain (Expiratory Tidal Volume/PEEP) + PEEP + Surrogate Strain Rate (Surrogate Strain/Ti) + Respiratory Rate + Expiratory Tidal Volume + Ti.

Conclusions

A substantial proportion of mechanically ventilated patients may be at risk of experiencing elevated levels of mechanical power. Despite observed differences in mechanical power values between VC and PC ventilation, they did not result in a significant disparity in the prevalence of high mechanical power values.