TY - JOUR
T1 - Mechanical power of ventilation is associated with mortality in critically ill patients
T2 - an analysis of patients in two observational cohorts
AU - Serpa Neto, Ary
AU - Deliberato, Rodrigo Octavio
AU - Johnson, Alistair E.W.
AU - Bos, Lieuwe D.
AU - Amorim, Pedro
AU - Pereira, Silvio Moreto
AU - Cazati, Denise Carnieli
AU - Cordioli, Ricardo L.
AU - Correa, Thiago Domingos
AU - Pollard, Tom J.
AU - Schettino, Guilherme P.P.
AU - Timenetsky, Karina T.
AU - Celi, Leo A.
AU - Pelosi, Paolo
AU - Gama de Abreu, Marcelo
AU - Schultz, Marcus J.
AU - for the PROVE Network Investigators
PY - 2018/11
Y1 - 2018/11
N2 - Purpose: 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. Methods: 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. Results: 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. Conclusion: 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.
AB - Purpose: 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. Methods: 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. Results: 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. Conclusion: 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.
KW - Critically ill
KW - Intensive care unit
KW - Mechanical power
KW - Mechanical ventilation
KW - Mortality
KW - Ventilator-induced lung injury
UR - http://www.scopus.com/inward/record.url?scp=85054565031&partnerID=8YFLogxK
U2 - 10.1007/s00134-018-5375-6
DO - 10.1007/s00134-018-5375-6
M3 - Article
C2 - 30291378
AN - SCOPUS:85054565031
SN - 0342-4642
VL - 44
SP - 1914
EP - 1922
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 11
ER -