Effect of mechanical power on intensive care mortality in ARDS patients.
Acute respiratory distress syndrome
Compliance
Intensive care mortality
Lung size
Mechanical power
Ventilator-induced lung injury
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
24 05 2020
24 05 2020
Historique:
received:
06
02
2020
accepted:
08
05
2020
entrez:
26
5
2020
pubmed:
26
5
2020
medline:
14
1
2021
Statut:
epublish
Résumé
In ARDS patients, mechanical ventilation should minimize ventilator-induced lung injury. The mechanical power which is the energy per unit time released to the respiratory system according to the applied tidal volume, PEEP, respiratory rate, and flow should reflect the ventilator-induced lung injury. However, similar levels of mechanical power applied in different lung sizes could be associated to different effects. The aim of this study was to assess the role both of the mechanical power and of the transpulmonary mechanical power, normalized to predicted body weight, respiratory system compliance, lung volume, and amount of aerated tissue on intensive care mortality. Retrospective analysis of ARDS patients previously enrolled in seven published studies. All patients were sedated, paralyzed, and mechanically ventilated. After 20 min from a recruitment maneuver, partitioned respiratory mechanics measurements and blood gas analyses were performed with a PEEP of 5 cmH Two hundred twenty-two ARDS patients were included; 88 (40%) died in ICU. Mechanical power was not different between survivors and non-survivors 14.97 [11.51-18.44] vs. 15.46 [12.33-21.45] J/min and did not affect intensive care mortality. The multivariable robust regression models showed that the mechanical power normalized to well-inflated tissue (RR 2.69 [95% CI 1.10-6.56], p = 0.029) and the mechanical power normalized to respiratory system compliance (RR 1.79 [95% CI 1.16-2.76], p = 0.008) were independently associated with intensive care mortality after adjusting for age, SAPS II, and ARDS severity. Also, transpulmonary mechanical power normalized to respiratory system compliance and to well-inflated tissue significantly increased intensive care mortality (RR 1.74 [1.11-2.70], p = 0.015; RR 3.01 [1.15-7.91], p = 0.025). In our ARDS population, there is not a causal relationship between the mechanical power itself and mortality, while mechanical power normalized to the compliance or to the amount of well-aerated tissue is independently associated to the intensive care mortality. Further studies are needed to confirm this data.
Sections du résumé
BACKGROUND
In ARDS patients, mechanical ventilation should minimize ventilator-induced lung injury. The mechanical power which is the energy per unit time released to the respiratory system according to the applied tidal volume, PEEP, respiratory rate, and flow should reflect the ventilator-induced lung injury. However, similar levels of mechanical power applied in different lung sizes could be associated to different effects. The aim of this study was to assess the role both of the mechanical power and of the transpulmonary mechanical power, normalized to predicted body weight, respiratory system compliance, lung volume, and amount of aerated tissue on intensive care mortality.
METHODS
Retrospective analysis of ARDS patients previously enrolled in seven published studies. All patients were sedated, paralyzed, and mechanically ventilated. After 20 min from a recruitment maneuver, partitioned respiratory mechanics measurements and blood gas analyses were performed with a PEEP of 5 cmH
RESULTS
Two hundred twenty-two ARDS patients were included; 88 (40%) died in ICU. Mechanical power was not different between survivors and non-survivors 14.97 [11.51-18.44] vs. 15.46 [12.33-21.45] J/min and did not affect intensive care mortality. The multivariable robust regression models showed that the mechanical power normalized to well-inflated tissue (RR 2.69 [95% CI 1.10-6.56], p = 0.029) and the mechanical power normalized to respiratory system compliance (RR 1.79 [95% CI 1.16-2.76], p = 0.008) were independently associated with intensive care mortality after adjusting for age, SAPS II, and ARDS severity. Also, transpulmonary mechanical power normalized to respiratory system compliance and to well-inflated tissue significantly increased intensive care mortality (RR 1.74 [1.11-2.70], p = 0.015; RR 3.01 [1.15-7.91], p = 0.025).
CONCLUSIONS
In our ARDS population, there is not a causal relationship between the mechanical power itself and mortality, while mechanical power normalized to the compliance or to the amount of well-aerated tissue is independently associated to the intensive care mortality. Further studies are needed to confirm this data.
Identifiants
pubmed: 32448389
doi: 10.1186/s13054-020-02963-x
pii: 10.1186/s13054-020-02963-x
pmc: PMC7245621
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
246Références
Crit Care Med. 2015 Apr;43(4):781-90
pubmed: 25513785
Anesthesiology. 2019 Jan;130(1):119-130
pubmed: 30277932
Crit Care. 2016 Aug 22;20:276
pubmed: 27545828
Crit Care Med. 2014 Feb;42(2):252-64
pubmed: 24196193
Intensive Care Med. 2012 Oct;38(10):1573-82
pubmed: 22926653
JAMA. 2012 Jun 20;307(23):2526-33
pubmed: 22797452
Am J Respir Crit Care Med. 2017 May 1;195(9):1253-1263
pubmed: 28459336
N Engl J Med. 2015 Feb 19;372(8):747-55
pubmed: 25693014
Intensive Care Med. 2016 Oct;42(10):1597-1600
pubmed: 27637717
Crit Care. 2016 Apr 06;20:86
pubmed: 27048605
Crit Care Med. 2013 Apr;41(4):935-44
pubmed: 23385101
Eur Respir J Suppl. 2003 Nov;47:15s-25s
pubmed: 14621113
Respir Care. 2016 May;61(5):689-99
pubmed: 27121623
Intensive Care Med Exp. 2019 Jul 25;7(Suppl 1):38
pubmed: 31346828
N Engl J Med. 2000 May 4;342(18):1301-8
pubmed: 10793162
Intensive Care Med. 2005 Jun;31(6):776-84
pubmed: 15812622
Intensive Care Med. 2019 Jun;45(6):856-864
pubmed: 31062050
Intensive Care Med. 2018 Nov;44(11):1914-1922
pubmed: 30291378
Am J Respir Crit Care Med. 2020 Apr 1;201(7):767-774
pubmed: 31665612
Ann Am Thorac Soc. 2019 Oct;16(10):1263-1272
pubmed: 31247145
Crit Care Clin. 2018 Jul;34(3):343-356
pubmed: 29907269
Intensive Care Med. 2016 May;42(5):663-673
pubmed: 26781952
Eur Respir J. 2016 Jan;47(1):233-42
pubmed: 26493798
Am J Respir Crit Care Med. 2019 Oct 15;200(8):1002-1012
pubmed: 31144997
Intensive Care Med. 2017 May;43(5):603-611
pubmed: 28283699
Crit Care. 2019 Nov 27;23(1):375
pubmed: 31775830
Am J Respir Crit Care Med. 1999 Jul;160(1):109-16
pubmed: 10390387
Intensive Care Med. 2016 Oct;42(10):1567-1575
pubmed: 27620287
Ann Intensive Care. 2016 Dec;6(1):13
pubmed: 26868503
N Engl J Med. 2006 Apr 27;354(17):1775-86
pubmed: 16641394
Ann Intern Med. 2009 Oct 20;151(8):566-76
pubmed: 19841457
Crit Care. 2017 Jul 12;21(1):183
pubmed: 28701178
Crit Care. 2011 Apr 07;15(2):304
pubmed: 21489320
Am J Respir Crit Care Med. 2018 Jun 15;197(12):1586-1595
pubmed: 29345967
Chest. 2016 Nov;150(5):1109-1117
pubmed: 27477213
N Engl J Med. 2014 Mar 6;370(10):980
pubmed: 24597883
Am J Respir Crit Care Med. 2008 Aug 15;178(4):346-55
pubmed: 18451319
Intensive Care Med. 2016 Dec;42(12):1865-1876
pubmed: 27757516
Am J Respir Crit Care Med. 2016 Jun 1;193(11):1254-63
pubmed: 26699672
Am J Epidemiol. 2004 Apr 1;159(7):702-6
pubmed: 15033648
Am J Respir Crit Care Med. 2001 Nov 1;164(9):1701-11
pubmed: 11719313
Crit Care. 2017 Sep 12;21(1):240
pubmed: 28899408
Chest. 1986 Jan;89(1):56-63
pubmed: 3940790
Crit Care Med. 2018 Nov;46(11):1761-1768
pubmed: 30048331
Crit Care. 2016 Nov 29;20(1):384
pubmed: 27894328
Anesthesiology. 2016 May;124(5):1100-8
pubmed: 26872367
JAMA. 2008 Feb 13;299(6):637-45
pubmed: 18270352
Ann Transl Med. 2017 Jul;5(14):286
pubmed: 28828361
Shock. 2018 Mar;49(3):311-316
pubmed: 28846571