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Vol. 48. Issue 3.
Pages 155-164 (March 2024)
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Vol. 48. Issue 3.
Pages 155-164 (March 2024)
Comprehensive study of mechanical power in controlled mechanical ventilation: Prevalence of elevated mechanical power and component analysis
Estudio Integral de la Potencia Mecánica en la Ventilación Mecánica Controlada: Prevalencia de Potencia Mecánica Elevada y Análisis de Componentes
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Alejandro González-Castroa,
Corresponding author
jandro120475@hotmail.com

Corresponding author.
, Alberto Medina Villanuevab, Patricia Escudero-Achaa, Aurio Fajardo Campoverdic, Federico Gordo Vidald, Ignacio Martin-Loechese, Angelo Roncalli Rochaf,g, Marta Costa Romeroh, Marianela Hernández Lópezi, Carlos Ferrandoj,k, Alessandro Prottil,m, Vicent Modesto i Alapontn, Mechanical Power Day Group
a Department of Intensive Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
b Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
c Critical Care Unit, Hospital Biprovincial Quillota-Petorca, Chile
d Department of Intensive Medicine, Hospital Universitario del Henares, Coslada-Madrid, Research Group for Critical Pathology, Universidad Francisco de Vitoria, Madrid, Spain
e JFICMI, Consultant in Intensive Care Medicine, St James's University Hospital, Dublin, Ireland
f Rehabilitation Division, Hélvio Auto Hospital, Alagoas, Brazil
g University Center Cesmac, Alagoas, Brazil
h Neonatology Department, Hospital Universitario de Cabueñes, Gijón, Spain
i Department of Intensive Medicine, Hospital Universitario de Álava, Vitoria-Gasteiz, Spain
j Anesthesiology and Resuscitation Service, Clinic University Hospital of Barcelona, Spain
k CIBER Respiratory Diseases, ISCIII, Madrid, Spain
l IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy
m Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
n Department of Anesthesiology and Pediatric Critical Care, Hospital Universitari i Politecnic La Fe de Valencia, Spain
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Tables (5)
Table 1. Characteristics of the cohort of 372 patients ventilated in controlled mode.
Table 2. Main differences between patients ventilated under pressure control and patients ventilated under volume control.
Table 3. Main differences in mechanical power values and ventilatory parameters between patients undergoing pressure-controlled ventilation and patients undergoing volume-controlled ventilation.
Table 4. Model weights of evidence against the best one (in deciBans), for patients under volume control.
Table 5. Model weights of evidence against the best one (in deciBans), for patients under pressure control.
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Abstract
Objective

To determine the prevalence of elevated mechanical power (MP) values (>17J/min) used in routine clinical practice.

Design

Observational, descriptive, cross-sectional, analytical, multicenter, international study conducted on November 21, 2019, from 8:00 AM to 3:00 PM. NCT03936231.

Setting

One hundred thirty-three Critical Care Units.

Patients

Patients receiving invasive mechanical ventilation for any cause.

Interventions

None.

Main variables of interest

Mechanical power.

Results

A population of 372 patients was analyzed. PM was significantly higher in patients under pressure-controlled ventilation (PC) compared to volume-controlled ventilation (VC) (19.20±8.44J/min vs. 16.01±6.88J/min; p<0.001), but the percentage of patients with PM>17J/min was not different (41% vs. 35%, respectively; p=0.382). The best models according to AICcw expressing PM for patients in VC are described as follows: Surrogate Strain (Driving Pressure) + PEEP+Surrogate Strain Rate (PEEP/Flow Ratio) + Respiratory Rate. For patients in PC, it is defined as: Surrogate Strain (Expiratory Tidal Volume/PEEP) + PEEP+Surrogate Strain Rate (Surrogate Strain/Ti) + Respiratory Rate+Expiratory Tidal Volume+Ti.

Conclusions

A substantial proportion of mechanically ventilated patients may be at risk of experiencing elevated levels of mechanical power. Despite observed differences in mechanical power values between VC and PC ventilation, they did not result in a significant disparity in the prevalence of high mechanical power values.

Keywords:
Mechanical ventilation
Mechanical power
Strain
Strain rate
Resumen
Objetivo

Determinar la prevalencia de valores elevados de potencia mecánica (PM) (>17J/min) utilizados en la práctica clínica habitual.

Diseño

estudio observacional, descriptivo de corte transversal, analítico, multicéntrico e internacional, realizado el 21 de noviembre de 2019 en horario de 8 a 15 horas. NCT03936231.

Ámbito

Ciento treinta y tres Unidad de Cuidados Críticos.

Pacientes

pacientes que recibirán ventilación mecánica por cualquier causa.

Intervenciones

ninguna

Variables de interés principales

Potencia mecánica.

Resultados

se analizaron 372 enfermos. La PM fue significativamente mayor en pacientes en ventilación controlada por presión (PC) que en ventilación controlada por volumen (VC) (19,20+8,44J/min frente a 16,01+6,88J/min; p<0,001), pero el porcentaje de pacientes con PM>17J/min no fue diferente (41% frente a 35% respectivamente; p=0,382). Los mejores modelos según AICcw que expresan la PM para los enfermos en VC se decribe como: Strain subrogante (Presión de conducción) + PEEP+Strain Rate subrogante (PEEP/cociente de flujo) + Frecuencia respiratoria. Para los enfermos en PC se define como: Strain subrogante (Volumen tidal expiratorio/PEEP) + PEEP+Strain Rate subrogante (Strain subrogante/Ti) + Frecuencia respiratoria+Expiratory Tidal Volumen+Ti.

Conclusiones

Gran parte de los pacientes en ventilación mecánica en condiciones de práctica clínica habitual reciben niveles de potencia mecánica peligrosos. A pesar de las diferencias observadas en los valores de potencia mecánica entre la ventilación VC y PC, este porcentaje de riesgo fue similar en PC y VC.

Palabras clave:
Ventilación mecánica
Mechanical power
Strain
Strain rate

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