Elastic static power, its correlation with acute respiratory distress syndrome severity: A Bayesian post-hoc analysis of the Mechanical Power Day cross-sectional trial.

Summary

In a multicenter Bayesian post-hoc analysis of the Mechanical Power Day cross-sectional cohort, elastic static power showed the strongest independent correlation with ARDS severity compared with other mechanical power components. Values increased from 5.8 J/min in mild ARDS to 7.4 J/min in moderate/severe ARDS, with posterior means indicating stronger associations.

Key Findings

• Elastic static power was 5.8 J/min in mild ARDS and 7.4 J/min in moderate/severe ARDS.
• Bayesian regression showed independent correlations for mild (posterior mean 1.3; 95% CrI 0.2-2.2) and moderate/severe ARDS (posterior mean 2.8; 95% CrI 1.7-3.8), stronger than other power equations.
• Analysis spanned 113 ICUs across 15 countries, increasing generalizability.

Clinical Implications

Elastic static power could be prioritized for bedside monitoring and ventilator adjustments to mitigate ventilator-induced lung injury and to stratify ARDS severity. Thresholds linked to outcomes warrant prospective evaluation.

Limitations

• Post-hoc analysis of cross-sectional data limits causal inference
• Potential confounding by ventilator settings and unmeasured clinical factors; prospective validation lacking

Future Directions

Prospective studies to validate elastic static power thresholds, assess outcome associations, and test ventilation strategies targeting reductions in elastic static power.