The Mechanical Power in Patients with Acute Respiratory Distress Syndrome Undergoing Prone Positioning Can Predict Mortality
Ko-Wei Chang,
Shaw-Woei Leu,
Han-Chung Hu,
Ming-Cheng Chan,
Shinn-Jye Liang,
Kuang-Yao Yang,
Li-Chung Chiu,
Wen-Feng Fang,
Chau-Chyun Sheu,
Ying-Chun Chien,
Chung-Kan Peng,
Ching-Tzu Huang,
Kuo-Chin Kao
Affiliations
Ko-Wei Chang
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Shaw-Woei Leu
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Han-Chung Hu
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Ming-Cheng Chan
Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
Shinn-Jye Liang
Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan
Kuang-Yao Yang
Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
Li-Chung Chiu
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Wen-Feng Fang
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
Chau-Chyun Sheu
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
Ying-Chun Chien
Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
Chung-Kan Peng
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Ching-Tzu Huang
Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Kuo-Chin Kao
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Background/Objectives: Mechanical power (MP) refers to ventilator-delivered energy to the lungs, which may induce lung injury. We examined the relationship between MP and mortality in patients with acute respiratory distress syndrome (ARDS) who underwent prone positioning. Methods: This multicenter retrospective study included data on all patients admitted to the intensive care units of eight referral hospitals in Taiwan from October 2015 to March 2016, and in Chang Gung Memorial Hospital Linkou branch from January 2017 to October 2023. The data were obtained from the electronic medical records of each hospital by using a standard case report form. MP was calculated as follows: MP (J/min) = 0.098 × VT × RR × (Ppeak − 1/2 × ΔP). Results: We included 135 patients who underwent prone positioning. Among them, 28-day survivors had significantly lower MP (22.6 ± 6.5 vs. 25.3 ± 6.2 J/min, p = 0.024), MP/predicted body weight (PBW) (396.9 ± 118.9 vs. 449.3 ± 118.8 10−3 J/min/kg, p = 0.018), MP/compliance values (0.8 ± 0.3 vs. 1.1 ± 0.4 J/min/mL/cmH2O, p = 0.048) after prone positioning, and significantly lower changes in MP, MP/PBW, and MP/compliance (−0.6 ± 5.7 vs. 2.5 ± 7.4 J/min, p = 0.007; −9.2 ± 97.5 vs. 42.1 ± 127.9 10−3 J/min/kg, p = 0.010; −0.1 ± 0.3 vs. 0.2 ± 0.3 J/min/mL/cmH2O, p p Conclusions: In ARDS patients treated with prone positioning, MP/compliance, and change in MP, MP/PBW, and MP/compliance after prone positioning differed significantly between 28-day survivors and nonsurvivors. Further randomized controlled research is required to elucidate the potential causality of decreased MP and improved clinical outcomes.
