Respiratory failure & ventilation
Power, Duration, and Compliance: Reframing Risk of Ventilatory-Induced Lung Injury With the Risk-Adjusted Mechanical-Power Score
Authors' conclusion
A single "safe" MP threshold is insufficient for guiding ventilation; the risk of lung injury is governed by a dynamic interplay of power intensity, duration, and the patient's respiratory compliance.
Study context
- Population
- Mechanically ventilated adults with oxygenation consistent with moderate to severe ARDS, ICUs in the Netherlands (2003–2016) and US (2008–2019)
- Participants
- 2,150 participants
- Exposure
- Mechanical power (MP) intensity and cumulative time above MP thresholds, stratified by respiratory compliance
- Outcome
- Risk from MP exposure by respiratory compliance
Methodological details2 large ICU datasets, time-dependent Cox proportional hazards models stratified by respiratory compliance
- 2 large ICU datasets
- Time-dependent Cox proportional hazards models stratified by respiratory compliance
Main finding
As reported in the abstract
Higher compliance: dose-response pattern, immediate hazard beginning at 10 J/min, cumulative harm amplifying significantly over time
HR = 1.04
Low compliance: risk confined to a narrow power band without evidence of cumulative harm
11-20 J/min
Observational data: associations, not effects.
Further findings
Prediction of outcome by risk-adjusted MP score (eXtreme Gradient Boosting)
- AUC
- 0.863
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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