The Association Between Mechanical Power Within the First 24 Hours and ICU Mortality in Mechanically Ventilated Adult Patients With Acute Hypoxemic Respiratory Failure: A Registry-Based Cohort Study.

Summary

Across 9,031 mechanically ventilated adults with acute hypoxemic respiratory failure, higher mechanical power within the first 24 hours was independently associated with higher ICU mortality (OR 1.58), fewer ventilator-free days, and lower extubation rates, with no safe threshold identified.

Key Findings

• High mechanical power (>17 J/min) in the first 24 hours was associated with higher ICU mortality (adjusted OR 1.58; 95% CI 1.44–1.72).
• Nonlinear dose-response relationship observed; no consistent safe threshold of mechanical power identified.
• High MP was linked to lower extubation rates and fewer ventilator-free days.

Clinical Implications

Consider incorporating mechanical power into bedside ventilator management and aim to minimize MP early (e.g., by optimizing VT, RR, Pplat/PEEP) alongside conventional lung-protective strategies.

Limitations

• Observational design with residual confounding; mechanical power components may reflect severity and clinician choices
• Modeling relies on dynamic driving pressure; generalizability to all ventilator modes requires caution

Future Directions

Randomized trials testing mechanical power–targeted ventilation strategies and evaluating causal effects on mortality and VILI biomarkers.