Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands.
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Albert Einstein Avenue, 700, São Paulo, Brazil.
Intensive Care Med. 2018 Nov;44(11):1914-1922. doi: 10.1007/s00134-018-5375-6. Epub 2018 Oct 5.
Mechanical power (MP) may unify variables known to be related to development of ventilator-induced lung injury. The aim of this study is to examine the association between MP and mortality in critically ill patients receiving invasive ventilation for at least 48 h.
This is an analysis of data stored in the databases of the MIMIC-III and eICU. Critically ill patients receiving invasive ventilation for at least 48 h were included. The exposure of interest was MP. The primary outcome was in-hospital mortality.
Data from 8207 patients were analyzed. Median MP during the second 24 h was 21.4 (16.2-28.1) J/min in MIMIC-III and 16.0 (11.7-22.1) J/min in eICU. MP was independently associated with in-hospital mortality [odds ratio per 5 J/min increase (OR) 1.06 (95% confidence interval (CI) 1.01-1.11); p = 0.021 in MIMIC-III, and 1.10 (1.02-1.18); p = 0.010 in eICU]. MP was also associated with ICU mortality, 30-day mortality, and with ventilator-free days, ICU and hospital length of stay. Even at low tidal volume, high MP was associated with in-hospital mortality [OR 1.70 (1.32-2.18); p < 0.001] and other secondary outcomes. Finally, there is a consistent increase in the risk of death with MP higher than 17.0 J/min.
High MP of ventilation is independently associated with higher in-hospital mortality and several other outcomes in ICU patients receiving invasive ventilation for at least 48 h.
机械功率（MP）可能使与呼吸机诱导性肺损伤发展相关的变量统一。本研究的目的是研究至少接受 48 小时有创通气的危重症患者中 MP 与死亡率之间的关系。
这是对存储在 MIMIC-III 和 eICU 数据库中的数据进行的分析。纳入至少接受 48 小时有创通气的危重症患者。感兴趣的暴露是 MP。主要结局是院内死亡率。
分析了 8207 例患者的数据。MIMIC-III 中第二 24 小时的中位 MP 为 21.4（16.2-28.1）J/min，eICU 中为 16.0（11.7-22.1）J/min。MP 与院内死亡率独立相关[每增加 5 J/min 的优势比（OR）1.06（95%置信区间（CI）1.01-1.11）；p=0.021 在 MIMIC-III 中，eICU 中为 1.10（1.02-1.18）；p=0.010]。MP 还与 ICU 死亡率、30 天死亡率以及无呼吸机天数、ICU 和住院时间相关。即使在低潮气量下，高 MP 也与院内死亡率[OR 1.70（1.32-2.18）；p<0.001]和其他次要结局相关。最后，随着 MP 高于 17.0 J/min，死亡风险持续增加。
至少接受 48 小时有创通气的 ICU 患者，高 MP 与较高的院内死亡率和其他几个 ICU 结局独立相关。
