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Background <p>The relative contribution of the different components of mechanical power to mortality is a subject of debate and has not been studied in COVID-19. The aim of this study is to evaluate both the total and the relative impact of each of the components of mechanical power on mortality in a well-characterized cohort of patients with COVID-19-induced acute respiratory failure undergoing invasive mechanical ventilation. This is a secondary analysis of the CIBERESUCICOVID project, a multicenter observational cohort study including fifty Spanish intensive care units that included COVID-19 mechanically ventilated patients between February 2020 and December 2021. We examined the association between mechanical power and its components (elastic static, elastic dynamic, total elastic and resistive power) with 90-day mortality after adjusting for confounders in seven hundred ninety-nine patients with COVID-19-induced respiratory failure undergoing invasive mechanical ventilation.</p> Results <p>At the initiation of mechanical ventilation, the PaO<sub>2</sub>/FiO<sub>2</sub> ratio was 106 (78; 150), ventilatory ratio was 1.69 (1.40; 2.05), and respiratory system compliance was 35.7 (29.2; 44.5) ml/cmH<sub>2</sub>O. Mechanical power at the initiation of mechanical ventilation was 24.3 (18.9; 29.6) J/min, showing no significant changes after three days. In multivariable regression analyses, mechanical power and its components were not associated with 90-day mortality at the start of mechanical ventilation. After three days, total elastic and elastic static power were associated with higher 90-day mortality, but this relationship was also found for positive end-expiratory pressure.</p> Conclusions <p>Neither mechanical power nor its components were independently associated with mortality in COVID-19-induced acute respiratory failure at the start of MV. Nevertheless, after three days, static elastic power and total elastic power were associated with lower odds of survival. Positive end-expiratory pressure and plateau pressure, however, captured this risk in a similar manner.</p>

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Mechanical power is not associated with mortality in COVID-19 mechanically ventilated patients

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  • 发表日期：

    2025年2月25日

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  • Enric Barbeta,
  • Cláudia Barreiros,
  • Edoardo Forin,
  • Amedeo Guzzardella,
  • Anna Motos,
  • Laia Fernández-Barat,
  • Albert Gabarrús,
  • Adrián Ceccato,
  • Ricard Ferrer,
  • Jordi Riera,
  • Oscar Peñuelas,
  • José Ángel Lorente,
  • David de Gonzalo-Calvo,
  • Jessica Gonzalez,
  • Rosario Amaya-Villar,
  • José Manuel Añón,
  • Ana Balan,
  • Carme Barberà,
  • José Barberán,
  • Aaron Blandino,
  • Maria Victoria Boado,
  • Elena Bustamante-Munguira,
  • Jesús Caballero,
  • María Luisa Cantón-Bulnes,
  • Cristina Carbajales,
  • Nieves Carbonell,
  • Mercedes Catalán-González,
  • Nieves Franco,
  • Cristóbal Galbán,
  • Víctor D. Gumucio-Sanguino,
  • Maria Del Carmen de la Torre,
  • Emilio Díaz,
  • Ángel Estella,
  • Elena Gallego,
  • José Manuel Gómez,
  • Arturo Huerta,
  • Ruth Noemí Jorge García,
  • Ana Loza-Vázquez,
  • Judith Marin-Corral,
  • María Cruz Martin Delgado,
  • Amalia Martínez,
  • Ignacio Martínez,
  • Juan Lopez,
  • Guillermo M. Albaiceta,
  • María Teresa Nieto,
  • Mariana Andrea Novo,
  • Yhivian Peñasco,
  • Felipe Pérez-García,
  • Pilar Ricart,
  • Alejandro Rodríguez,
  • Victor Sagredo,
  • Angel Sánchez-Miralles,
  • Susana Sancho,
  • Ferran Roche-Campo,
  • Lorenzo Socias,
  • Jordi Solé-Violan,
  • Luis Tamayo,
  • José Trenado,
  • Alejandro Úbeda,
  • Luis Jorge Valdivia,
  • Pablo Vidal,
  • Ferran Barbé,
  • Jordi Vallverdú,
  • Antoni Torres,
  • Berta Adell-Serrano,
  • Alexander Agrifoglio,
  • María Aguilar Cabello,
  • Luciano Aguilera,
  • Victoria Alcaraz-Serrano,
  • Cesar Aldecoa,
  • Cynthia Alegre,
  • Sergio Álvarez,
  • Antonjo Álvarez Ruiz,
  • Rut Andrea,
  • José Ángel,
  • Marta Arrieta,
  • J. Ignacio Ayestarán,
  • Joan Ramon Badia,
  • Mariona Badía,
  • Orville Báez Pravia,
  • Begoña Balsera,
  • Laura Barbena,
  • Tommaso Bardi,
  • Patricia Barral Segade,
  • Marta Barroso,
  • José Ángel Berezo García,
  • Judit Bigas,
  • Rafael Blancas,
  • María Luisa Blasco Cortés,
  • María Boado,
  • María Bodi Saera,
  • Neus Bofill,
  • María Teresa Bouza Vieiro,
  • Leticia Bueno,
  • Juan Bustamante-Munguira,
  • Lucia Cachafeiro,
  • David Campi Hermoso,
  • Sandra Campos Fernández,
  • Iosune Cano,
  • Maria Luisa Cantón-Bulnes,
  • Pablo Cardina Fernández,
  • Laura Carrión García,
  • Sula Carvalho,
  • Núria Casacuberta-Barberà,
  • Manuel Castellà,
  • Andrea Castellví,
  • Pedro Castro,
  • Ramon Cicuendez Ávila,
  • Catia Cillóniz,
  • Luisa Clar,
  • Cristina Climent,
  • Jordi Codina,
  • Pamela Conde,
  • Sofía Contreras,
  • María Cruz Martin,
  • Raul de Pablo Sánchez,
  • Diego De Mendoza,
  • Cecilia del Busto Martínez,
  • Yolanda Díaz,
  • María Digna Rivas Vilas,
  • Cristina Dólera Moreno,
  • Irene Dot,
  • Pedro Enríquez Giraudo,
  • Inés Esmorís Arijón,
  • Teresa Farre Monjo,
  • Javier Fernández,
  • Carlos Ferrando,
  • Albert Figueras,
  • Eva Forcadell-Ferreres,
  • Lorena Forcelledo Espina,
  • Àngels Furro,
  • Felipe García,
  • Beatriz García,
  • Emilio García Prieto,
  • Carlos García Redruello,
  • Amaia García Sagastume,
  • Maria Luisa Gascón Castillo,
  • Gemma Gomà,
  • Vanesa Gómez Casal,
  • Silvia Gómez,
  • Carmen Gómez Gonzalez,
  • Jessica González,
  • Federico Gordo,
  • Maria Pilar Gracia,
  • Alba Herraiz,
  • Rubén Herrán-Monge,
  • Mercedes Ibarz,
  • Silvia Iglesias,
  • Maria Teresa Janer,
  • Gabriel Jiménez,
  • Mar Juan Díaz,
  • Karsa Kiarostami,
  • Juan I. Lazo Álvarez,
  • Miguel León,
  • Alexandre López-Gavín,
  • Ana López Lago,
  • Desire Macias Guerrero,
  • Nuria Mamolar Herrera,
  • Rafael Mañez Mendiluce,
  • Cecilia L Mantellini,
  • Gregorio Marco Naya,
  • Pilar Marcos,
  • Enrique Marmol Peis,
  • Paula Martín Vicente,
  • María Martínez,
  • Carmen Eulalia Martínez Fernández,
  • Maria Dolores Martínez Juan,
  • Juan Fernando Masa Jimenez,
  • Joan Ramon Masclans,
  • Emilio Maseda,
  • Eva María Menor Fernández,
  • Mar Miralbés,
  • Josman Monclou,
  • Juan Carlos Montejo-González,
  • Neus Montserrat,
  • María Mora Aznar,
  • Pedro Moral-Parras,
  • Dulce Morales,
  • Sara Guadalupe Moreno Cano,
  • David Mosquera Rodríguez,
  • Rosana Muñoz-Bermúdez,
  • José María Nicolás,
  • Ramon Nogue Bou,
  • Rafaela Nogueras Salinas,
  • Marta Ocón,
  • Ana Ortega,
  • Sergio Ossa,
  • Pablo Pagliarani,
  • Anna Parera Pous,
  • Francisco Parrilla,
  • Leire Pérez Bastida,
  • Purificación Pérez,
  • Gloria Pérez Planelles,
  • Eva Pérez Rubio,
  • David Pestaña Laguna,
  • Àngels Piñol-Tena,
  • Javier Prados,
  • Andrés Pujol,
  • Núria Ramon Coll,
  • Gloria Renedo Sanchez-Giron,
  • Laura Rodriguez,
  • Felipe Rodríguez de Castro,
  • Silvia Rodríguez,
  • Covadonga Rodríguez Ruiz,
  • Jorge Rubio,
  • Alberto Rubio López,
  • Miriam Ruiz Miralles,
  • Pablo Ryan Murúa,
  • Eva Saborido Paz,
  • Ana Salazar Degracia,
  • Miguel Sanchez,
  • Ana Sánchez,
  • Bitor Santacoloma,
  • Maria Teresa Sariñena,
  • Marta Segura Pensado,
  • Lidia Serra,
  • Mireia Serra-Fortuny,
  • Ainhoa Serrano Lázaro,
  • Lluís Servià,
  • Laura Soliva,
  • Carla Speziale,
  • Daniel Tognetti,
  • Adrián Tormos,
  • Mateu Torres,
  • Sandra Trefler,
  • Javier Trujillano,
  • Luis Urrelo-Cerrón,
  • Estela Val,
  • Luis Valdivia Ruiz,
  • Montse Vallverdú,
  • Maria Van der Hofstadt Martin-Montalvo,
  • Sabela Vara Adrio,
  • Nil Vázquez,
  • Javier Vengoechea,
  • Pablo Vidal Cortes,
  • Clara Vilà-Vilardel,
  • Judit Vilanova,
  • Tatiana Villada Warrington,
  • Hua Yang,
  • Minlan Yang,
  • Ana Zapatero,
  • Júlia Vidal

摘要

Background

The relative contribution of the different components of mechanical power to mortality is a subject of debate and has not been studied in COVID-19. The aim of this study is to evaluate both the total and the relative impact of each of the components of mechanical power on mortality in a well-characterized cohort of patients with COVID-19-induced acute respiratory failure undergoing invasive mechanical ventilation. This is a secondary analysis of the CIBERESUCICOVID project, a multicenter observational cohort study including fifty Spanish intensive care units that included COVID-19 mechanically ventilated patients between February 2020 and December 2021. We examined the association between mechanical power and its components (elastic static, elastic dynamic, total elastic and resistive power) with 90-day mortality after adjusting for confounders in seven hundred ninety-nine patients with COVID-19-induced respiratory failure undergoing invasive mechanical ventilation.

Results

At the initiation of mechanical ventilation, the PaO2/FiO2 ratio was 106 (78; 150), ventilatory ratio was 1.69 (1.40; 2.05), and respiratory system compliance was 35.7 (29.2; 44.5) ml/cmH2O. Mechanical power at the initiation of mechanical ventilation was 24.3 (18.9; 29.6) J/min, showing no significant changes after three days. In multivariable regression analyses, mechanical power and its components were not associated with 90-day mortality at the start of mechanical ventilation. After three days, total elastic and elastic static power were associated with higher 90-day mortality, but this relationship was also found for positive end-expiratory pressure.

Conclusions

Neither mechanical power nor its components were independently associated with mortality in COVID-19-induced acute respiratory failure at the start of MV. Nevertheless, after three days, static elastic power and total elastic power were associated with lower odds of survival. Positive end-expiratory pressure and plateau pressure, however, captured this risk in a similar manner.