Respiratory failure & ventilation
Mechanical Power Ratio and Respiratory Treatment Escalation in COVID-19 Pneumonia: A Secondary Analysis of a Prospectively Enrolled Cohort
Authors' conclusion
In this COVID-19 cohort, tidal volume was similar in patients undergoing treatment escalation and in patients who did not; mechanical power, its ratio, and pressure-rate index were the variables presenting the highest association with the clinical outcome.
Study context
- Population
- Spontaneously breathing adults with COVID-19 pneumonia receiving CPAP, enrolled September 2020 to December 2021
- Participants
- 111 participants
- Comparison
- Treatment escalation vs no-treatment escalation
Methodological detailsconsecutive enrolment
- Consecutive enrolment
Primary result
As reported in the abstract
Day-1 lung mechanics and predictive indices, treatment escalation vs no-treatment escalation · Day 1
| Group | Value | Respiratory rate (breaths/min) | Minute ventilation (l/min) | Tidal pleural pressure (cm H2O) | Mechanical power ratio | PAO2/FiO2 |
|---|---|---|---|---|---|---|
| Treatment escalation | mean 7.1 (SD 1.9) ml/kgIBW | 20 ± 5 | 9.2 ± 3.0 | 8.1 ± 3.7 | 2.4 ± 1.4 | 174 ± 64 |
| No-treatment escalation | mean 7.1 (SD 1.4) ml/kgIBW | 18 ± 5 | 7.9 ± 2.4 | 6.0 ± 3.1 | 1.7 ± 1.5 | 220 ± 95 |
Value
Treatment escalationmean 7.1 (SD 1.9) ml/kgIBW
No-treatment escalationmean 7.1 (SD 1.4) ml/kgIBW
Respiratory rate (breaths/min)
Treatment escalation20 ± 5
No-treatment escalation18 ± 5
Minute ventilation (l/min)
Treatment escalation9.2 ± 3.0
No-treatment escalation7.9 ± 2.4
Tidal pleural pressure (cm H2O)
Treatment escalation8.1 ± 3.7
No-treatment escalation6.0 ± 3.1
Mechanical power ratio
Treatment escalation2.4 ± 1.4
No-treatment escalation1.7 ± 1.5
PAO2/FiO2
Treatment escalation174 ± 64
No-treatment escalation220 ± 95
- Mechanical power AUC
- 0.738 (95% CI 0.636 to 0.839; P < 0.001)
- Mechanical power ratio AUC
- 0.734 (95% CI 0.625 to 0.844; P < 0.001)
- Pressure-rate index AUC
- 0.733 (95% CI 0.631 to 0.835; P < 0.001)
Further findings
Discrimination of treatment escalation (AUC)
| AUC (95% CI) | P value | |
|---|---|---|
| Mechanical power | 0.738 (0.636–0.839) | P < 0.001 |
| Mechanical power ratio | 0.734 (0.625–0.844) | P < 0.001 |
| Pressure-rate index | 0.733 (0.631–0.835) | P < 0.001 |
- Highest AUCs among variables
Original publication
Mechanical Power Ratio and Respiratory Treatment Escalation in COVID-19 Pneumonia: A Secondary Analysis of a Prospectively Enrolled Cohort. Anesthesiology. Published 26 December 2022. doi:10.
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