Investigation of Prolonged Mechanical Ventilation Mediating the Association Between Mechanical Power and Mortality After Cardiac Surgery

doi:10.1213/ane.0000000000007945

Cardiothoracic & vascular anesthesia

Investigation of Prolonged Mechanical Ventilation Mediating the Association Between Mechanical Power and Mortality After Cardiac Surgery

Anesth AnalgPublished 12 Feb 2026Retrospective cohort study

Main finding · Operative mortalityResultOdds ratio 1.102 95% CI 1.030–1.179

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Authors' conclusion

We found that higher levels of mechanical power were associated with intraoperative and late mortality, and this association was mediated by prolonged mechanical ventilation.

Study context

Population: Adult cardiac surgery patients
Participants: 5,907 patients

Exposure: Intraoperative mechanical power
Outcome: Operative mortality, with prolonged mechanical ventilation as mediator

Methodological detailssingle-centre, mediation analysis

Single-centre
Mediation analysis

Main finding

Operative mortality

Odds ratio

1.102

95% CI 1.030–1.179

P = 0.005

By group

First quartile1.9%

Last quartile3.8%

Mechanical power (per J/min)

OR 1.102 (95% CI 1.030–1.179); P = 0.005

Per J/min, as printed

As reported in the abstract

Operative mortality overall: 136 (2.3%)

Observational data: associations, not effects.

Secondary outcomes

Late mortality (survivors of the perioperative period) · median follow-up 792 (161-1496) days

First7.7%

Last9.7%

Prolonged mechanical ventilation

	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
MP2Square term of transformation	0.512	1.015 (1.008–1.021)	P < 0.001
MP3Cubic term of transformation	0.512	0.99961 (0.99930–0.99991)	P = 0.012
	0.512Odds ratio (log scale)

Outcome	← Lower vs mean mechanical power = 7.9 J/min ←→ Higher vs mean mechanical power = 7.9 J/min →	Combined OR (95% CI)
Prolonged mechanical ventilationMechanical power = 6 vs mean mechanical power = 7.9 J/min	0.10.31310	0.746 (0.622–0.891)
Prolonged mechanical ventilation10 vs mean mechanical power = 7.9 J/min · mechanical power = 10 J/min	0.10.31310	1.431 (1.108–1.857)
Prolonged mechanical ventilation14 J/min vs mean mechanical power = 7.9 J/min · mechanical power = 14 J/min	0.10.31310	3.033 (1.109–8.222)
	0.10.31310Combined OR (log scale)

Late mortality (survivors of the perioperative period) — Overall late mortality: 462 of 5771 (8.0%)

Mediation analysis

All of mechanical power's association with operative mortality mediated via prolonged mechanical ventilation

Original publication

Investigation of Prolonged Mechanical Ventilation Mediating the Association Between Mechanical Power and Mortality After Cardiac Surgery. Anesth Analg. Published 12 February 2026. doi:10.1213/ane.0000000000007945

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