Mechanical power and driving pressure as predictors of mortality among patients with ARDS
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LETTER
Mechanical power and driving pressure as predictors of mortality among patients with ARDS Joseph E. Tonna1,2* , Ithan Peltan3,4 , Samuel M. Brown3,4 , Jennifer S. Herrick5 and Heather T. Keenan6 on behalf of the University of Utah Mechanical Power Study Group © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, The postulated importance of mechanical power is that it provides a unifying concept combining the interaction of all the individual components of mechanical ventilation with the patient. Derived from the equation of motion, mechanical power calculates the energy delivered over time to the respiratory system by the ventilator [1]. Physiologically, mechanical power incorporates tidal volume, pressure, and additional parameters not included in driving pressure [2]. Previous studies demonstrated an association of power with mortality [3–5], but were primarily in non-ARDS populations [4], lacked consistent findings within all ARDS severities [3], or were unadjusted and descriptive of a single mechanical power threshold [5]. None assessed whether the association of mechanical power and mortality was independent from driving pressure. To assess the relative strength of association of mechanical power and driving pressure (ΔP) with mortality, we pooled patients from three randomized controlled trials of ARDS. Methods are detailed in the Online data supplement, but briefly, we reconstructed the adjusted Cox proportional hazards model from the Amato et al. driving pressure [2] study (Table E1) and examined the relationship between ΔP with mortality, mechanical power *Correspondence: [email protected] 1 Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA Full author information is available at the end of the article
The University of Utah Mechanical Power Study Group collaborators names are listed in Acknowledgement section.
with mortality, and, after checking for correlation and multicollinearity, we combined both ΔP and mechanical power in the same model. We also visually examined the relationship of ΔP and mechanical power with mortality. We analyzed patients not making respiratory efforts, and did a sensitivity analysis on patients making respiratory efforts. We found that among 1294 patients without respiratory efforts (Figure E1, Table E2), ΔP was significantly associated, in adjusted analysis, with 60-day hospital mortality (hazard ratio [HR] 1.44 [95% CI 1.28, 1.62; p
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