The Association between Mechanical Power and Mortality in Patients with Pneumonia Using Pressure-Targeted Ventilation.

Huang-Pin Wu,Chien-Ming Chu,Shaw-Woei Leu,Pi-Hua Liu,Li-Pang Chuang,Kuo-Chin Kao,Ko-Wei Chang,Shih-Wei Lin,Li-Chung Chiu

doi:10.3390/diagnostics11101862

Huang-Pin Wu, Chien-Ming Chu + Show 7 more

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https://doi.org/10.3390/diagnostics11101862

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Journal: Diagnostics	Publication Date: Oct 10, 2021
Citations: 7	License type: CC BY 4.0

Affiliation: Chang Gung Memorial Hospital, Chang Gung University

Abstract

Recent studies have reported that mechanical power (MP) is associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). We aimed to investigate the association between 28-day mortality and MP in patients with severe pneumonia. In total, the data of 313 patients with severe pneumonia were used for analysis. Serial MP was calculated daily for either 21 days or until ventilator support was no longer required. Compared with the non-ARDS group, the ARDS group (106 patients) demonstrated lower age, a higher Acute Physiology and Chronic Health Evaluation II score, lower history of diabetes mellitus, elevated incidences of shock and jaundice, higher MP and driving pressure on Day 1, and more deaths within 28 days. Regression analysis revealed that MP was an independent factor associated with 28-day mortality (odds ratio, 1.048; 95% confidence interval, 1.020–1.077). MP was persistently high in non-survivors and low in survivors among the ARDS group, the non-ARDS group, and all patients. These findings indicate that MP is associated with the 28-day mortality in ventilated patients with severe pneumonia, both in the ARDS and non-ARDS groups. MP had a better predicted value for the 28-day mortality than the driving pressure.

Highlights

Ventilated patients with inappropriate ventilator settings may further develop lung injury
A total of 61 acute respiratory distress syndrome (ARDS) patients and 56 nonARDS patients died within 28 days of intensive care unit (ICU) admission during the course of this study
Our study demonstrated that this simplified formula was easy to use, and the mechanical power (MP) calculated had an acceptable discrimination for 28-day mortality

Summary

Introduction

Ventilated patients with inappropriate ventilator settings may further develop lung injury. Studies have suggested several lung protective strategies to minimize ventilatorinduced lung injury (VILI) [1,2,3]. These studies recommend specific mechanical ventilation settings for patients with or without acute respiratory distress syndrome (ARDS), including (1) low tidal volume ventilation (6 mL/kg predicted body weight (PBW)), (2) relatively higher positive end-expiratory pressure (PEEP), and (3) using an upper-limit goal for end-inspiratory plateau pressures of 30 cm H2 O [1,3,4]. In patients with severe ARDS receiving extracorporeal membrane oxygenation (ECMO), higher driving pressure during the first three days of ECMO support was independently associated with increased mortality [6].

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