Annals of Intensive Care (Feb 2025)

Mechanical power is not associated with mortality in COVID-19 mechanically ventilated patients

  • Enric Barbeta,
  • Cláudia Barreiros,
  • Edoardo Forin,
  • Amedeo Guzzardella,
  • Anna Motos,
  • Laia Fernández-Barat,
  • Albert Gabarrús,
  • Adrián Ceccato,
  • Ricard Ferrer,
  • Jordi Riera,
  • Oscar Peñuelas,
  • José Ángel Lorente,
  • David de Gonzalo-Calvo,
  • Jessica Gonzalez,
  • Rosario Amaya-Villar,
  • José Manuel Añón,
  • Ana Balan,
  • Carme Barberà,
  • José Barberán,
  • Aaron Blandino,
  • Maria Victoria Boado,
  • Elena Bustamante-Munguira,
  • Jesús Caballero,
  • María Luisa Cantón-Bulnes,
  • Cristina Carbajales,
  • Nieves Carbonell,
  • Mercedes Catalán-González,
  • Nieves Franco,
  • Cristóbal Galbán,
  • Víctor D. Gumucio-Sanguino,
  • Maria Del Carmen de la Torre,
  • Emilio Díaz,
  • Ángel Estella,
  • Elena Gallego,
  • José Manuel Gómez,
  • Arturo Huerta,
  • Ruth Noemí Jorge García,
  • Ana Loza-Vázquez,
  • Judith Marin-Corral,
  • María Cruz Martin Delgado,
  • Amalia Martínez,
  • Ignacio Martínez,
  • Juan Lopez,
  • Guillermo M. Albaiceta,
  • María Teresa Nieto,
  • Mariana Andrea Novo,
  • Yhivian Peñasco,
  • Felipe Pérez-García,
  • Pilar Ricart,
  • Alejandro Rodríguez,
  • Victor Sagredo,
  • Angel Sánchez-Miralles,
  • Susana Sancho,
  • Ferran Roche-Campo,
  • Lorenzo Socias,
  • Jordi Solé-Violan,
  • Luis Tamayo,
  • José Trenado,
  • Alejandro Úbeda,
  • Luis Jorge Valdivia,
  • Pablo Vidal,
  • Ferran Barbé,
  • Jordi Vallverdú,
  • Antoni Torres,
  • CIBERESUCICOVID Project investigators (COV20/00110, ISCIII)

DOI
https://doi.org/10.1186/s13613-025-01430-6
Journal volume & issue
Vol. 15, no. 1
pp. 1 – 11

Abstract

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Abstract Background The relative contribution of the different components of mechanical power to mortality is a subject of debate and has not been studied in COVID-19. The aim of this study is to evaluate both the total and the relative impact of each of the components of mechanical power on mortality in a well-characterized cohort of patients with COVID-19-induced acute respiratory failure undergoing invasive mechanical ventilation. This is a secondary analysis of the CIBERESUCICOVID project, a multicenter observational cohort study including fifty Spanish intensive care units that included COVID-19 mechanically ventilated patients between February 2020 and December 2021. We examined the association between mechanical power and its components (elastic static, elastic dynamic, total elastic and resistive power) with 90-day mortality after adjusting for confounders in seven hundred ninety-nine patients with COVID-19-induced respiratory failure undergoing invasive mechanical ventilation. Results At the initiation of mechanical ventilation, the PaO2/FiO2 ratio was 106 (78; 150), ventilatory ratio was 1.69 (1.40; 2.05), and respiratory system compliance was 35.7 (29.2; 44.5) ml/cmH2O. Mechanical power at the initiation of mechanical ventilation was 24.3 (18.9; 29.6) J/min, showing no significant changes after three days. In multivariable regression analyses, mechanical power and its components were not associated with 90-day mortality at the start of mechanical ventilation. After three days, total elastic and elastic static power were associated with higher 90-day mortality, but this relationship was also found for positive end-expiratory pressure. Conclusions Neither mechanical power nor its components were independently associated with mortality in COVID-19-induced acute respiratory failure at the start of MV. Nevertheless, after three days, static elastic power and total elastic power were associated with lower odds of survival. Positive end-expiratory pressure and plateau pressure, however, captured this risk in a similar manner.

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