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

In 9,031 IMV patients with AHRF, higher mechanical power during the first 24 hours was independently associated with increased ICU mortality, with a nonlinear dose-response and no consistent safe threshold. High MP also correlated with lower extubation rates and fewer ventilator-free days, supporting early strategies to reduce MP.

Key Findings

• High mechanical power within 24 hours of IMV was associated with higher ICU mortality (OR 1.58; 95% CI 1.44–1.72).
• No consistent safe mechanical power threshold was identified; the relationship was nonlinear.
• High MP was linked to lower extubation rates and fewer ventilator-free days.

Clinical Implications

At IMV initiation, prioritize strategies that lower mechanical power (e.g., reducing driving pressure, tidal volume, respiratory rate, and inspiratory flow) and consider MP as a monitoring target alongside traditional lung-protective parameters.

Limitations

• Observational design precludes causal inference.
• Exact mechanical power components and ventilator practices may vary across centers.

Future Directions

Randomized or adaptive trials testing early MP-targeted ventilation bundles and evaluating patient-centered outcomes; validation of dynamic MP monitoring tools.