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KMID : 1144420240390010091
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Acute and Critical Care
2024 Volume.39 No. 1 p.91 ~ p.99
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Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
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Sim Jae-Kyeom
Lee Sang-Min
Kang Hyung-Koo
Kim Kyung-Chan
Kim Young-Sam
Kim Yun-Seong
Lee Won-Yeon
Park Sung-Hoon
Park So-Young
Park Ju-Hee
Sim Yun-Su
Lee Kwang-Ha
Lee Yeon-Joo
Lee Jin-Hwa
Lee Heung-Bum
Lim Chae-Man
Choi Won-Il
Hong Ji-Young
Song Won-Jun
Suh Gee-Young
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Abstract
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Background: Mechanical power (MP), which integrates ventilator variables affecting ventilator-induced lung injury, has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality.
Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV=0.098 ? RR ? VT ? (ΔPinsp + PEEP). Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed.
Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029?1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579).
Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.
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KEYWORD
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artificial respiration, intensive care unit, mechanical ventilators, mortality
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