Goedegebuur Jamilla, Smits Floor E, Snoep Jacob W M, Rietveld Petra J, van der Velde Franciska, de Jonge Evert, Schoe Abraham
Department of Thrombosis and Hemostastis, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands.
Crit Care Explor. 2024 Dec 19;6(12):e1190. doi: 10.1097/CCE.0000000000001190. eCollection 2024 Dec 1.
Mechanical power (MP) could serve as a valuable parameter in clinical practice to estimate the likelihood of adverse outcomes. However, the safety thresholds for MP in mechanical ventilation remain underexplored and contentious.
This study aims to investigate the association between MP and hospital mortality across varying degrees of lung disease severity, classified by Pao2/Fio2 ratios.
DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective cohort study using automatically extracted data. Patients admitted to the ICU of a tertiary referral hospital in The Netherlands between 2018 and 2024 and ventilated in pressure-controlled mode were included.
Logistic regression, adjusted for age, sex, Acute Physiology and Chronic Health Evaluation-IV score, and Pao2/Fio2 ratio, was used to calculate the odds ratio (OR) for all-cause in-hospital mortality.
A total of 2184 patients were analyzed, with a mean age of 62.5 ± 13.8 years, of whom 1508 (70.2%) were male. The mean MP was highest in patients with the lowest Pao2/Fio2 ratios (21.5 ± 6.5 J/min) compared with those with the highest ratios (12.0 ± 3.8 J/min; p < 0.001). Adjusted analyses revealed that increased MP was associated with higher mortality (OR, 1.06; 95% CI, 1.03-1.09 per J/min increase). Similarly, MP normalized for body weight showed a stronger association with mortality (OR, 1.004; 95% CI, 1.002-1.006 per J/min/kg increase). An increase in mortality was seen when MP exceeded 16-18 J/min.
Our findings demonstrate a significant association between MP and hospital mortality, even after adjusting for key confounders. Mortality increases notably when MP exceeds 16-18 J/min. Normalized MP presents an even stronger association with mortality. These results underscore the need for further research into ventilation strategies that consider MP adjustments.
机械功率（MP）可作为临床实践中评估不良结局可能性的一个有价值参数。然而，机械通气中MP的安全阈值仍未得到充分探索且存在争议。
本研究旨在调查不同程度肺部疾病严重程度（根据动脉血氧分压/吸入氧分数值（Pao2/Fio2）比值分类）下MP与医院死亡率之间的关联。
设计、设置和参与者：这是一项使用自动提取数据的回顾性队列研究。纳入了2018年至2024年期间在荷兰一家三级转诊医院重症监护病房（ICU）住院且采用压力控制模式通气的患者。
采用逻辑回归分析，对年龄、性别、急性生理与慢性健康状况评分系统IV（APACHE-IV）评分以及Pao2/Fio2比值进行校正，计算全因院内死亡率的比值比（OR）。
共分析了2184例患者，平均年龄为62.5±13.8岁，其中1508例（70.2%）为男性。与Pao2/Fio2比值最高的患者相比，Pao2/Fio2比值最低的患者平均MP最高（21.5±6.5焦耳/分钟）（P<0.001）。校正分析显示，MP升高与死亡率升高相关（OR为1.06；每增加1焦耳/分钟，95%置信区间为1.03 - 1.09）。同样，按体重标准化的MP与死亡率的关联更强（OR为1.004；每增加1焦耳/分钟/千克，95%置信区间为1.002 - 1.006）。当MP超过16 - 18焦耳/分钟时，死亡率会升高。
我们的研究结果表明，即使校正了关键混杂因素，MP与医院死亡率之间仍存在显著关联。当MP超过16 - 18焦耳/分钟时，死亡率显著增加。标准化MP与死亡率的关联更强。这些结果强调了有必要进一步研究考虑MP调整的通气策略。
